HomeMy WebLinkAbout07 - CC-6 - Attachment 1 - 3/3/2015CITY OF COSTA MESA, CALIFORNIA
ATTACHMENT 1
-� r u rc n a s e Ke q u i s i t i o n
Ail
Vendor ID:
(Leave Blank for Time
Stam
(Assigned by Purchasing)
Business Unit: CITY Date Requisitioned: 2/18/15
Department: I. T. Division: Como Systems De v
Ship To Address:
Contact Person: Steve El v Phone Number: 4891
Send Copy of P.O. to: ❑ Contact Person and / or Victoria
® Request is for Budgeted item(s)
❑ Request is for UNBUDGETED item(s)-(Memo Attached)
❑ Item(s) Pending Budget Amendment Request #
❑ Requesting Sole Source (Justification Form Attached)
❑ Fixed Asset Tag Request
Item
No.
Qty Unit
Items (Give Full Description: Size, Catalog No. Etc.)
Unit Price
Estimated
Amount
1
1 LT
PeopleSoft Support Services Agreement for 3/19/15 through 3/18/16
$ 115,855.00
ELECTRONIC DELIVERY ONLY
/f additional lines are needed, please attach a second sheet
Const./Prof. Svs. Agmt. Completion Date:
Insurance Required: ® Yes (Certificate attache ❑ No
Sales Tax (8.00%):
Include Shipping Fee:
Estimated Total Cost:
0.00
0.00
$115,855.00
Item #
Account
Fund
Dept./OM.
Program
Project
Amount
1
525702
101
14600
50710
$ 115,855.00
Comments:
Total$ 115,855.00
insurance documents to follow. Vendor's quote attached.
Suggested Vendor: RIMINI STREET
Address: 3993 HOWARD HUGHES PKWY, STE. 780
City, State, Zip Code: LAS VEGAS, NV 89169
Proper approvals are required before requisition can be processed.
Ordered By:
Department Director/Authorized Signature
Phone: 702-839-9671 Fax: 702-973-7491 Approved By:
Director of Finance/Purchasing Officer
Vendor's Contact Person: BILL COTE
Approved By:
nn,
PURCHASING DIVISION USE ONLY
Vendor ID:
Buyer:
Insurance valid thru
Ship To/Location:
I Due Date:
Standard Comments: ACC-ALL-ARR -BLA- CON -DCP- DIS- FCA-FCI- FIX - INS - IS - IST-ORG -QTR- REM - SUB -T&C
FINANCE DEPARTMENT USE ONLY
Available Appropriation: ❑ Yes ONO
As of:
Confirmed By:
2385-20 MW REV.3/10
Rev FY09/10