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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 6/1/2018 <br />BPW Datqr"== <br />Name Andy Myer, Assistant Chief, EMS <br />Department Fire <br />Phone 9255 <br />0 Legal Attorney Name Elliott Anderson <br />-a +- <br />0— <br />Controller review is required for all Contracts $5,000.00 or more, <br />Controller Z and greater than one year in length per the City Purchasing <br />aE <br />-0 CO Policy <br />U) Purchasing Z Michael Schmiidt <br />Check the ADr)ror)riate Item TvDe — Reauired for All Submissions <br />[:] <br />Agreement <br />❑ Contract ------7E] <br />Proposal <br />EE] Addendum <br />El <br />Claim <br />El <br />Bid Opening <br />Z <br />Bid Award <br />❑ Req. to Advertise <br />LEI -17itle, Sheet <br />[:1 <br />n <br />Quote, Opening <br />Chg Order No. <br />El <br />El <br />Quote Award <br />C/O & PCA No. E:] PCA <br />El <br />Ease./Encroach. <br />El <br />Traffic Control <br />❑I <br />Resolution <br />[:] <br />Other:, <br />elm MON, mt - - ---------- ---M <br />Company or Vendor Name <br />New Vendor <br />Physio Control <br />El Yes Z No El If Yes, Approved by Purchasing <br />MBE/WBE Contractor <br />❑ MBE E] WBE <br />Project Name <br />Funding Source <br />EMS Capital Fund-Eqluipment Purchase <br />Account No. <br />287.0902.422.43-10 <br />Amount <br />$ 208,147.92 <br />Terms of Contract <br />As invoiced, net 30 <br />�Purpose/Description <br />New monitors will replace older monitor/defibrillators <br />Amount of Li Increase $ <br />1:1 ---- <br />Previous Amount $ <br />Current Percent of Change: % <br />New Amount $ <br />Total Percent of Change: % <br />PO No. <br />Copy <br />Original <br />n <br />El <br />El <br />El <br />