HomeMy WebLinkAbout15 - CC-8 - Attachment 2 - 9/15/2015- CITY OF COSTA MESA, CALIFORNIA
Purchase Requisition
Vendor ID:
(Leave Blank for Time
Stamp)
Purchase Order
Nuber
(Assigned by Purchasing)
Business Unit: CITY Date Requisitioned: 8/13/15
Department: Development Sys Division: Planning
Ship To Address: 77 Fair Drive
Contact Person: Silvia Kennerson Phone Number: X5023
Send Copy of P.O. to: ® Contact Person and / or
❑ 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 1
Amendment Two for MIG's Professional Service Agreement-,
$ 39,400.00
Extend Contract Period By One 1 Year To October 1, 2016
Additional Scope of Work
If additional lines are needed, please attach a second sheet
Const./Prof. Svs. Agmt. Completion Date: 10/01/16
Insurance Required: ® Yes (Certificate attached) ❑ No
Sales Tax (8.00%):
Include Shipping Fee:
Estimated Total Cost:
$ 39,400.00
Item #
Account
Fund
Dept./Org.
Program
Project
Amount
1
530201
101
18200
20320
$ 39,400.00
Comments:
Total$ 39,400.00
Jose M. Rodriguez's Email Address: joser@migcom.com
$14,400 has been approved from the City's Contingency Fund.
Proper approvals are required before requisition can be processed.
Suggested Vendor: Moore lacofano Goltsman (MIG)
Address: 169 N. Marengo Avenue Ordered By:
City, State, Zip Code: Pasadena, CA 91101-1703
Phone: 626-744-9872 Fax: 626-744-9873 Approved By:
Vendor's Contact Person: Jose M. Rodriauez
Approved By:
Department Director/Authorized Signature
Director of Finance/Purchasing Officer
City Manager (when required)
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 [-]No
As of:
Confirmed By:
2385-20 MW REV.3/10
Rev FY12/13