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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />9/10118 <br />Sue Gerlach <br />Department IT <br />BPW Date 9/25/18 Phone Extension 6209 <br />Re aired Pno to Submittal to Board <br />Legal ® Attorney Name Sandra Kennedy <br />Controller ® Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />❑ Agreement U Contract jJ Proposal [_J Addendum <br />❑ Professional Services ❑ Resolution <br />❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ❑ Title Sheet <br />❑ Quote Opening ❑ Quote Award <br />❑ Change Order No. ❑ CIO & PCA No. ❑ PCA <br />❑ Ease/Encroach. ❑ Traffic Control <br />N Other: Lease Agreement <br />Company or Vendor Name Dell <br />New Vendor ❑ Yes ® No ❑ <br />MBENVBE Contractor ❑ MBE ❑ WBE <br />If Yes, Approved by Purchasing <br />MBEANBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name Dell Lease for Fire Equipment <br />Project Number NIA <br />Funding Source Capital Lease Proceeds. <br />Account No. Prin. 279-0672-415-38-01 Int. 279-0672-415-38-02 <br />Amount $ 7983.78 <br />Terms of Contract $1826.691 ear for 5 years <br />PurposelDescription Equipment for vehicle and backup <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc. <br />N s_, Retd For Ohara a Ostlers and M ❑❑ ' <br />a ...... . ✓ r ,.,� <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />Previous Amount <br />Current Percent of Change: <br />New Amount <br />Total Percent of Change: % <br />Dispersal After Approval <br />Copy <br />Original <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />