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(DI COTC PROCESSING FORM <br />Agreements /Amendments / Deeds <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: DEVELOPMENT ENGINEERING <br />N.2013A 58 <br />7013 #JOV -7 AN 9: 39 <br />t aA <br />ANA <br />rt€sf <br />MAIL STOP: M -93 <br />PROJECT MANAGER: ANDERSON CHRYSOSTOMO EXT.: 5839 <br />AGREEMENT NUMBER (if amendment): A / N NA <br />AMENDMENT NUMBER (if applicable): ❑ 1 ST ❑ 2ND ❑ 3RD ❑ <br />NAME OF CONSULTANT/ PARTY: HOUSING AUTHORITY OF THE CITY OF SANTA ANA <br />AMOUNT: ❑ * OVER $25,000 —(A) ❑ *UP TO $25,000 - (N) Note. It your agreement with a vendor exceeds $25,444 <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: NA ITEM #: <br />TERM OF AGREEMENT- EFFECTIVE DATE: <br />TERMINATION DATE: <br />SIGNATURES REQUIRED: ❑ VENDOR ❑ AGENCY <br />❑ CITY ATTORNEY FA OTHER <br />(INSURANCE APPROVAL REQUIRED BY CAD 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: SIGNATURE BY CITY MANAGER AND CITY CLERK ON CERTIFICATE OF <br />ACCEPTANCE FOR STREET EASEMENT. <br />* Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS -2717 <br />I:IAgreements\Form- AGREEMENT PROCESSING FORM _canary ,doc <br />Revised: 1/17/2012 <br />