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A-2007-296F <br />PAZ <br />p , COTC PROCESSING FORM Clear Form <br />t Agreements / Amendments / Deeds ��f5 <br />CITY CF <br />CL. '., , _ <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: Public Works MAIL STOP: M-36 <br />PROJECT MANAGER: Mindv Lv EXT.: 5665 <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 n/a <br />AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND ❑ 3RD ❑ A <br />NAME OF CONSULTANT / PARTY: Caltrans 3 o27�d 7 <br />AMOUNT: ❑ * OVER $25,000 — (A) m *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: N/A ITEM #: <br />TERM OF AGREEMENT- EFFECTIVE DATE: N/A TERMINATION DATE: N/A <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: Please attest the Executive Director of Public Works signature. Please call when ready <br />for nick uo. <br />K Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS-2717 <br />I. AgreementslForm -AGREEMENT PROCESSING FORM_canary.doc <br />Revised: 1/17/2012 <br />