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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 10/15/19.............................�.�........._.. <br />Name Sue Gerlach Department IT <br />BPW Date 10/22/19 Phone Extension 6209 <br />__ ........_.w. ..�..........w_ __.... <br />R_e uired Prior to Submittalto Board <br />BPW Attorney Attorney Name Clara Daniels <br />Dept. Attorney Attorney Name Sandra Kenned <br />Purchasing ® Michael Schmidt; <br />Check the A <br />Professional Services Agreement <br />E] Open Market Contract <br />❑ Bid Opening <br />Quote Opening <br />Proposal Opening <br />❑ Chg. Order, No. <br />'' Other: Dell Lease <br />pLoTliate ItemTyper- Requ <br />❑ Contract <br />❑ Amendment/Addendum <br />Bid Award <br />F] Quote Award <br />❑ C/O & PCA No. <br />❑ Traffic Control <br />Required Information <br />or All Submissions <br />L Proposal <br />❑] Special Purchase, QPA <br />❑I Req. to Advertise <br />Reject Bids/Quotes <br />�] PCA <br />Resolution <br />Ease./Encroach <br />❑ Title Sheet <br />Company or Vendor Name <br />Dell <br />❑ Yes❑ If Yes Approved by Purchasing <br />New Vendor <br />® No <br />MBE <br />MBE/WBE Contractor <br />❑ WBE Completed E-Verify Form Attached Nos <br />Project Name <br />Dell Lease �. ......................... ----- <br />Project Number <br />N/A <br />Funding Source <br />Capital Lease Proceeds ............ .....-- <br />Account No. <br />Prin. 279-0672-415-38.01 Int. 279-0672-415-38.02 <br />Amount <br />— _........................ ................. --.................... _......,_..................... <br />$4371.90 <br />Terms of Contract <br />$874.36/Annually for 5 years <br />Purpose/Description <br />Additional tablets for Fire tow.use ares when equ <br />F equipment is down. <br />For Change Orders Only��........m... <br />Amount of <br />El <br />Increase $ <br />0 <br />Decrease$ ) <br />Previous Amount <br />$ <br />Increase % <br />..............................%).............................................................................�--— -.. <br />Current Percent of Change: <br />Decrease( <br />New Amount <br />$ .... ..........�� _� .................. <br />... __�. �...,,___.._.. <br />Increase <br />e % <br />Total Percent of Change: <br />Decrease ( %) <br />Time Extension Amount: <br />.. <br />New Completion Date: <br />................ ....... . __ .........w _ . <br />