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y' COTC PROCESSING FORM <br />g Agreements / Amendments / Deeds <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: pl�jk /b� 4- (-- <br />PROJECT MANAGER: L✓)CW��VIVI <br />Clear Form <br />��. OkI <br />MAIL STOP: I r l 2,2 <br />EXT.: �( -� c,3 <br />The following information must be provided <br />in requesting processing of agreements /amendments / deeds for the City: <br />AGREEMENT NUMBER (if amendment): A / N zo QC::�'` <br />AMENDMENT NUMBER (if applicable): 1ST ❑2ND 3RD ❑ <br />NAME OF CONSULTANT I PARTY: <br />AMOUNT: ❑ * OVER $25,000 — (A) *UP TO $25;000 - (N) Note: if your agreement with a vendor exceeds $25,000 <br />within a Fiscal Year, then you will need to obtain Council <br />Approval. <br />❑ 1) NOT approved by council. <br />❑ 2) Approved by council. <br />COUNCIL APPROVAL DATE: ITEM #: <br />TERM OF AGREEMENT- EFFECTIVE DATE: '-aZ ��) TERMINATION DATE.' fW(-- <br />SIGNATURES REQUIRED: ---S] VENDOR ---E AGENCY <br />❑ CITY ATTORNEY ❑ 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 ❑ WORKERS COMPENSATION <br />COMMENTS: <br />OR CLERK OFFICE USE ON Y: ❑ PROCESS ❑ DO NOT PROCESS <br />❑ Needs Council Approval <br />\ ❑ Missing Signatures <br />te J n 0 n _❑ Other W 1p <br />* Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS-2717 <br />I:WgreementslForm - AGREEMENT PROCESSING FORM_canary.doc <br />Revised: 1/1712012 <br />