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A-2021-223-01 <br />. COTC PROCESSING FORM <br />UL <br />~ <br />Agreements / Amendments / Extensions/ Deeds ' <br />REVIVE FUNDED? COVID FUNDED? CONFIDENTIAL? <br />[]YES N NO ❑ YES N NO ❑ YES N NO <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: Public Works Agency <br />PROJECT MANAGER: Kenny Nguyen/M.Leger <br />MAIL STOP: M-43 <br />ExT.: 5019 <br />The following inbrimation must be provided <br />in requesting processing of agreements / amendments / extensions / deeds for the City: <br />(See page 2 for instructions on how to fill out the COTC form) <br />NAME OF CONSULTANT / PARTY: Monument ROW <br />AGREEMENT NUMBER (if applicable): A / N <br />AMENDMENT NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑ 4TH <br />(if applicable) : <br />EXTENSION NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑ 4TH <br />(if applicable): <br />An amend ment/extension requires a copy of a Staff Report and/or initial agreement to be included. <br />AMOUNT: N * OVER <br />$50,000 <br />❑ * $50,000 'Note: Council approval is required if an agreement with a <br />AND UNDER vendor exceeds $50,000 within a Fiscal Year for non. <br />public works agreements. <br />Bid for contracts exceeding $25 000, will continue to require <br />a formal Invitation for Bid. <br />❑ 1) Approved by council. ❑ 2) NOT approved by council. <br />COUNCIL APPROVAL DATE: 1 1-16-2021 ITEM #: 18 <br />TERMOFAGREEMENT EFFECTIVEDATE: 11-16-2021 TERMINATION DA TE: <br />11-15-2024 <br />SIGNATURES REQUIRED: N VENDOR 9 AGENCY ❑ CITY ATTORNEY ❑ OTHER <br />NOTARIZATION REQUIRED ❑ YES ❑ NO <br />APPROVEDINSURANCE: ❑ YES ❑ NO <br />(INSURANCE APPROVAL REQUIRED BY RISK MGMT. PRIOR TO SUBMITTING TO COTC) <br />COMMENTS: <br />FOR CLERK OFFICE USE ONLY: O PROCESS 0 DO NOT PROCESS <br />❑ Missing Signatures ❑ Needs Council Approval ❑ Other <br />ADDITIONAL REMARKS: <br />`ttrective Apnl its, zu19, tatty Manager contract authority increased via Ordinance NS-2963. <br />1:1Agreements1FormsTorm -AGREEMENT PROCESSING FORM-08-13-2021-FINALdoc Revised: 081132021 <br />Pagel d 2 <br />