HomeMy WebLinkAbout34 - NB-1 - Exhibit B - 6/17/2014EXHIBIT: B
CITY QF COS IA MtbA, t;ALIfUKNIA
Purchase Requisition
• -
{Leave Blank for Time
Stam
Purchase Order
Number
(Assigned by Purchasing)
Business Unit: CITY Date Requisitioned: 5120/14
Department: Development Svs Division: Planning
Ship To Address: 77 Fair Drive
Contact Person: Silvia Kennerson Phone Number: X5023
Send Copy of P.O. to: ® Contact Person and 1 or
❑ Request is for Budgeted item(s)
® Request is for QN13UDGETED item (s)-(yWemo Attached)
❑ item(s) Pending Budget Amendment Request #
❑ Requesting Sole Source (Justification Form Attached)
❑ Fixed Asset Tag Request
ItemQty
No.
Unit
Items (Give Full Description: Size, Catalog No. Etc.)
Unit Price
Estimated
Amount
1
1 1
Amendment One for MIG's Professional Service Agreement, Additional
$
Scope of Work, and Extend Contract Period By One 1 Year To
October 1, 2015.
From $134,800 up to $184,800 Depending On The Council Approved
Options.
11'athlitional limes are needed.. please attach a sc+eond sheet Sales Tax (8.00%):
Const./Prof. Svs. Agmt. Completion Date: Include Shipping Fee:
Insurance Required: ® Yes (Certificate attache ❑ No Estimated Total Cost:
$
Item #
Account
Fund
Dept./Org.
Program
Project
Amount
1
530200
101
18200
20320
S 100,000.00
Total$
Per Finance Director, $100,000 is coming from contingency funds (see attached staff report) and remaining balance will be
paid for through salary savings from FY13-14.
Proper approvals are required before requisition can be processed.
Suggested Vendor: 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. Rodriguez
Approved By:
Dept ent Di ctor/Authorized Sig ure
_ %96G— 14
Director of F r an ce/P u rch as i n g Officer
City Manager when re uired
PURCHASING DIVISION 1.15E ONLY
Vendor ID:
Buyer:
Insurance valid thru
Ship To/Location:
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. 3110