HomeMy WebLinkAbout30 - CC-11 - Attachment 3 - 7/7/2015ATTACHMENT 3
CITY OF COSTA MESA CALIFORNIA
-
'I Purchase Requisition
Vendor ID:
(Leave Blank for Time
Stam
Purchase Order
Assig ed by Purchasing)
Business Unit: CITY Date Requisitioned: 6/30/15
Department: I. T. Division: Comp Systems Dev
Ship To Address:
Contact Person: Jim Phone Number: 5044
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 LOT
SOFTWARE MAINTENANCE AND SERVICES RENEWAL
112,077.00
$ 112,077.00
Period of Coverage: 8/1-15 to 7131/16
Services provided will be as described in the Software Maintenance
Agreement signed on 7/23/13 between the City of Costa Mesa and
SunGard Public Sector
(f additional lines are needed, please attach a second sheet
Const./Prof. Svs. Agmt. Completion Date:
Insurance Require ® Yes (Certificate attache ❑ No
Sales Tax (8.00%):
Include Shipping Fee:
Estimated Total Cost:
0.00
$112,077.00
Item #
Account
Fund
Dept./Org.
Program
Project
Amount
1
525702
101
14600
50720
$ 112,077.00
Comments:
Total$ 112,077.00
Attached: Vendor's quote and insurance documents.
Suggested Vendor: SUNGARD PUBLIC SECTOR, INC.
Address: 1000 BUSINESS CENTER DRIVE
City, State, Zip Code: LAKE MARY, FL 32725-5585
Proper approvals are required before requisition can be processed.
Ordered By:
Department Director/Authorized Signature
Phone: 407-304-3322 Fax: 407-304-1277 Approved By:
Vendor's Contact Person: DEAN PAUR
Director of Finance/Purchasing Officer
Approved By:
Citv Mnnaner fwhan mnuirarh
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