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SAN A ANA CITY CLERK CITY CLERK PROCESSING FORM NOV -5°* F'M3°00 Agreements /Amendments / Extensions / Deeds REVIVE FUNDED? COVID FUNDED? CONFIDENTIAL? ❑YES ❑■ NO ❑YES • NO ❑YES 0 NO TO: CITY CLERK'S OFFICE FROM: DEPT.: PWA/Water Resources MAIL STOP: M-85 PROJECT MANAGER: Leif Lovegren EXT.: 3327 The following information must be provided in requesting processing of agreements/amendments/extensions/deeds for the City: (See page 2 for instructions on how to fill out the this form) NAME OF CONSULTANT/ PARTY: T.E. ROBERTS, INC. AGREEMENT NUMBER (if applicable): A / N A-2024-165-02 AMENDMENT NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑4TH (if applicable) : EXTENSION NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑4TH (if applicable): An amendment/extension requires a copy of a Staff Report and/or initial agreement to be included. AMOUNT:. * OVER ❑ * $50,000 *Note: Council approval is required if an agreement with a '.50,000 AND UNDER vendor exceeds $50,000 within a Fiscal Year for non- public works agreements. Bid for contracts exceeding$50,000.will continue to require a formal Invitation for Bid, ❑■ 1) Approved by council. ❑ 2) NOT approved by council. COUNCIL APPROVAL DATE: 10/15/24 ITEM #: 15 TERM OF AGREEMENT EFFECTIVE DATE: 10/15/24 TERMINATION DATE: 10/14/27 SIGNATURES REQUIRED: ❑ VENDOR ❑ AGENCY ❑ CITY ATTORNEY ( OTHER NOTARIZATION REQUIRED ❑ YES ] NO APPROVED INSURANCE: ❑ YES NO (INSURANCE APPROVAL REQUIRED BY RISK MGIIIIT. PRIOR TO SUBMITTING TO CITY CLERK) COMMENTS: cc-ill for p Lku X5(a‘_3 FOR CLERK OFFICE USE ONLY: 0 PROCESS 0 DO NOT PROCESS ❑ Missing Signatures 0 Needs Council Approval 0 Other ADDITIONAL REMARKS: _._.._........._.._.._.._.. - -1-1a5ur_.G,nc ._.. - --c` — *Effective July 6, 2023, City Manager contract authority increased via Ordinance NS-3041. I:1Agreements\Forms\Form-AGREEMENT PROCESSING FORM-06-19-2023-FINAL.doc Revised:06/19/2023 Page 1 of 2