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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date August 20th 2018 <br />Department Innovation and <br />Name Brian Donoghue Technology <br />BPW Date August ?%!' 2018 Phone Extension <br />Required Prior to Submittal to Board <br />Legal Attorney Name Sandra Kennedy <br />Controller review is required for all Contracts $5,000.00 or more <br />Controller and greater than one year in length per the City Purchasing <br />Policy <br />Purchasing F <br />Check the Appropriate Item Type — Required forAll Submissions <br />El Agreement M Contract ❑ Proposal El Addendum <br />M Professional Services F] Amendment I <br />F-1 Bid Opening F] Bid Award E] Req. to Advertise El Title Sheet <br />❑ Quote Opening F] Quote Award <br />❑ Chg Order No. El C/O & PCA No. ❑ PCA <br />El EaseJEncroach. ❑ Traffic Control ❑ Resolution <br />El Other: ®Claim <br />Required Information <br />Company or Vendor Name <br />New Vendor <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />If Yes, Approved Iby Purchasing <br />❑ MBE Completed E-Verify Form Attached El Yes <br />WBE ❑ No <br />Digital Access Sites <br />Innovation and Technology Supplies Account <br />279-0672-415-21-05 <br />Amount <br />Terms of Contract <br />Purpose/Description <br />$13,377.83 <br />Providing hardware, SmartNet, and professional services for <br />Charles Black Center— See memo <br />For Change Orders Only <br />Amount of El increase $ <br />n Decrease <br />$ <br />Previous Amount <br />$ <br />Current Percent of Change: <br />% - - <br />New Amount <br />$ <br />Total Percent of Change: <br />% <br />Time Extension: <br />Dispersal After Approval <br />Copy Original <br />❑ <br />El <br />