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Date <br />Name <br />BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />9110/18 <br />Sue Gerlach <br />Department IT <br />❑ Agreement ❑ Contract La Proposal LJ 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 />�l Other: Lease Agreement <br />Company or Vendor Name HP <br />New Vendor ❑ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBEAINBE Contractor ❑ MBE ❑ WBE <br />MBEIWBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name HP Computer Lease #19 <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 $ 36864.83 <br />Terms of Contract- $776.031Mo. For 48 Months <br />Purpose/Description Equipment for new or changed_ positions <br />❑ Required Contractor's Certification Form Attached (Non - <br />Collusion. Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <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 />