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SANTA ANA CITY CLERK <br />z e. COTC PROCESSING FORM UL23'24Pm3:0 <br />- <br />Agreements / Amendments / Extensions/ Deeds <br />rK <br />REVIVE FUNDED? [CO)VID FUNDED? CONFIDENTIA `- 4Pr3'-YY <br />[IYES ElNO ❑ YES ❑ NO ElYES ElNO <br />TO: CITY CLERK'S OFFICE <br />FROM: DEPT.: Planning Agency MAIL STOP: M-20 <br />PROJECT MANAGER: Nuvia Ocampo for Andrea Heywood EXT.: 2732 <br />The following information must be provided <br />in requesting processing of agreements / amendments / extensions / deeds for the City: <br />(See page 2 for instructions on how to fill out the COTC form) <br />NAME OF CONSULTANT / PARTY: Kelly S. Thomas and Bethany S. Thomas Trustees onf the Thomas Living Trust <br />AGREEMENT NUMBER (if applicable): A / N A-2024-055 <br />AMENDMENT NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑ 4TH <br />(if applicable) : <br />EXTENSION NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑ 4TH <br />(if applicable): <br />An amendment/extension requires a copy of a Staff Report and/or initial agreement to be included. <br />AMOUNT: ❑ * OVER <br />$50,000 <br />❑ * $50,000 *Note: Council approval is required if an agreement with a <br />AND UNDER vendor exceeds $50,000 within a Fiscal Year for non- <br />public works agreements. <br />Bid for contracts exceeding $25,000, will continue to reauire <br />9 1) Approved by council. <br />COUNCIL APPROVAL DATE: 5/7/2024 <br />a formal Invitation for Bid. <br />❑� 2) NOT approved by council. <br />ITEM #: 23 <br />TERM OF AGREEMENT EFFECTIVE DATE: N/A <br />SIGNATURES REQUIRED: ❑ VENDOR AGENCY <br />NOTARIZATION REQUIRED ❑� YES <br />APPROVED INSURANCE: ❑ YES <br />TERMINATION DATE: <br />N/A <br />❑ CITY ATTORNEY ❑ OTHER <br />❑ NO <br />❑ NO <br />(INSURANCE APPROVAL REQUIRED BY RISK MGMT. PRIOR TO SUBMITTING TO COTC) <br />COMMENTS: <br />Missing Signatures ❑ Needs Council Approval ❑ Other <br />DITIONALREMARKS: .�� 1�5 (7// AUu 0 6 NZ4 Scan-4 (( � <br />DITIO P <br />*Effective Ann] 18. 2019. Citv Manaaer contract authoritv increased via <br />I, AgreemenislFormslForm - AGREEMENT PROCESSING FORM-03107/2023-F I NAL.doc Revised: 03/07/2023 <br />Page 1 of 2 <br />