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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 11 /5/2018 <br />Name Kvra Clark <br />Department Human Capital& <br />Inclusion <br />BPW Date 11/13/2018 Phone Extension 7500 <br />to Submittal to Board ............ <br />Legal ® Attorney Name Danielle Campbell <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 />Check the ooroodat Item Tvoe Racuired for All Suhmissihns <br />IXJ Agreement <br />Professional Services <br />Bid Opening <br />[:1 Quote Opening <br />El Change Order No. <br />❑ Ease/Encroach. <br />Other: <br />❑ Contract <br />Resolution <br />Bid Award <br />El Quote Award <br />]] C/O & PCA No. <br />❑ Traffic Control <br />Proposal <br />❑ Req. to Advertise <br />❑ PCA <br />Addendum <br />❑ Title Sheet <br />Company or Vendor Name ACCORDWARE LLC <br />New Vendor EJ Yes ® No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE [:] WBE <br />MBE/WBE Contractor Requested ® No n Yes Name of Company <br />IRS Forms 1094-C & 1095-C <br />Project Name ACA Reportingfor _................... ._.......... .... . <br />Project Number <br />Funding Source Health In ___. _...... <br />surance Fund .............���.�—.m.�... <br />Account No. 711-0401-671-31-06 <br />Amount$1.25 per 1095-C Formand$100 per employee reporting fee <br />(approximately 1,400 forms/employees); $1,250.00 Base Fee. <br />Postage will be billed as an at cost pass through cost to the <br />Citv. <br />Terms of Contract <br />The agreement covers the reporting period for the 2018 calendar <br />Purpose/Description Accordware LLC will assist with fulfillment of the Cit ys re ortin <br />obligations pursuant to the Patient Protection and Affordable Care <br />Act to satisfv 1094 & 1095 re ortin re uirements with regard to the <br />RS. <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 />