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COTC PROCESSING FORM <br />A.yf <br />Agreements / Amendments / Deeds <br />Project Manager is responsible to ensure agreement has been ZniQ NOV 2 pM 5• reviewed and approved by City Attorney, all exhibits attached, 10 <br />Certificate of Insurance meets mandatory coverage, complies <br />with CMO contract authority as defined in NS-2963, and CITY OF SANTA ANA <br />ultimately, agreement is ready for City Manager execution. CLERK OF COUNCIL <br />COTC will only be responsible for attestation of CMO signature. <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: (_�/1ZJ 70tfl % Aelo — /X664//f/9 MAIL STOP: <br />PROJECT MANAGER: / c"&JI EXT.: v5� <br />The following information must be provided <br />in requesting processing of agreements / amendments / deeds for the C <br />AGREEMENT NUMBER (if amendment): A / N k_2DI°I_ 191 <br />AMENDMENT NUMBER (if applicable) <br />NAME OF CONSULTANT / PARTY: <br />AMOUNT: ❑ * OVER <br />$50,000 — (A) <br />1ST ❑ 2ND -, ❑ 3RD ❑ <br />❑ *UP TO "Note: Council approval is required if an agreement with a <br />$50,000 - (AIN) vendor exceeds $50,000 within a Fiscal Year for non- <br />public works agreements. <br />Bid for contracts exceeding $25,000, will continue to <br />require a formal Invitation for Bid. <br />❑ 1) Approved by council. ❑ 2) NOT approved by council. <br />�J <br />COUNCIL APPROVAL DATE: 1.S p1 p/ ITEM #: <br />TERM OF AGREEMENT EFFECTIVE DATE: TERMINATION DATE: <br />SIGNATURES REQUIRED: ❑ VENDOR ❑ AGENCY ❑ CITY ATTORNEY <br />❑ OTHER <br />(INSURANCE APPROVAL REQUIRED BY CAO PRIOR TO SUBMITTING TO COTC) <br />INSURANCE REQUIRED: ❑ YES ❑ NO (Provide City Attorney Office approval) <br />❑ AUTO ❑ CGL (Commercial General Liability) <br />❑ PROFESSIONAL LIABILITY i❑ WORKERS COMPENSATION <br />COMMENTS: <br />FOR CLERK OFFICE USE ONLY: ❑ PROCESS ❑ DO NOT PROCESS <br />❑ Missing Signatures ❑ Needs Council Approval ❑ Other <br />ADDITIONAL REMARKS: <br />Effective April 16, 2019, City Manager contract authority increased via Ordinance NS-2963. <br />IaAgreementslForm -AGREEMENT PROCESSING FORM_canary_REVISED.doc Revised: 4/1812019 <br />