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CITY CLERK PROCESSING FORM <br />C) Agreements / Amendments / Extensions / Deeds <br />REVIVE FUNDED_?]COVID FUNDED? CONFIDENTIAL? <br />El YES El NO ❑YES ❑ NO DYES ❑ NO <br />TO: CITY CLERK'S OFFICE <br />FROM: DEPT.: PRCSA MAIL STOP: M-23 <br />PROJECT MANAGER: t-'jt�.ncUQ � Cptn EXT.: 4228 <br />The following information must be provided <br />in requesting processing of agreements / amendments / extensions / deeds forthe C ity: <br />(See page 2 for instructions on how to fill out the this form) <br />NAME OF CONSULTANT / PARTY: <br />AGREEMENT NUMBER (if applicable):... .. <br />AMENDMENTNUMBER ❑ 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 * $50,000 *Note: Council approval is required if an agreement with a <br />$50,000 AID UNDER vendor exceeds $50,000 within a Fiscal Year for non- <br />public works agreements. <br />Bid for contracts exceeding $50,000, will continue to require <br />a formal Invitation for Bid. <br />❑ 1) Approved by council. ❑ 2) NOT approved by council. <br />COUNCIL APPROVAL DATE: ITEM #: <br />TERM OF AGREEMENT EFFECTIVE DATE: Nov • ZO I JA 1 Lj TERMINATION DATE: WV • 19 I 0 L�_ <br />SIGNATURES REQUIRED: 4 VENDOR <br />NOTARIZATION REQUIRED ❑ YES <br />APPROVED INSURANCE: ❑ YES <br />P AGENCY 99 CITYATTORNEY ❑ OTHER <br />ffl <br />(INSURANCE APPROVAL REQUIRED BY RISK MGMT. PRIOR TO SUBMITTING TO CITY CLERK) <br />COMMENTS: <br />FOR CLERK OFFICE USE ONLY: ❑ PROCESS ❑ DO NOT PROCESS <br />❑ Missing Signatures ❑ Needs Council Approval ❑ Other <br />ADDITIONAL REMARKS: <br />.,� y I.. , vwy IVldIIOlJZI UUnudUL duuiUI Ly inGtedSeo via urainance N5-3U41. <br />I. IAgreementslFormslForm - AGREEMENT PROCESSING FORM-06-19-2023-FINAL.doc Revised: 06/19/2023 <br />Page 1 of 2 <br />