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COTC PROCESSING FORM <br />Agreements / Amendments / Deeds <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: Santa Ana Police Department <br />nF'(' 22 I'M 5X13 <br />OF SANITA I`,NA <br />Rh OF C';c)UNM! <br />MAIL STOP: M-97 <br />PROJECT MANAGER: W-Rebert-C- arreli- (f rn d A. . son j'a f V EXT <br />8135 <br />AGREEMENT NUMBER (if amendment): A / N A- 2013 -183 / ` t <br />AMENDMENT NUMBER (if applicable): ❑ 2ND F] 3RD ❑ <br />NAME OF CONSULTANT/ PARTX-' Siemens Industry, Inic <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: 11 -11 -13 /'r- - TERMINATION DATE. 5 -31 -15 / <br />SIGNATURES REQUIRED: ❑ VENDOR ❑ 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: Insurance Renal ONLY. Xevvalkovers both Agreements listed above. <br />FOR CLERK OFFICE USE ONLY: ❑ PROCESS ❑ DO NOT PROCESS -Tt c ""0 <br />❑ Needs Council Approval« cIj <br />❑ Missing Signatures > r a <br />❑ Other <br />ADDITIONAL REMARKS: <br />........ ....... ...__.__.____. <br />* Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS -2717 <br />1:1Agreennents\Fornn - AGREEMENT PROCESSING FORM--canary doc <br />Revised: 1 /17/2012 <br />