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SANTA AIM CITY -+. <br /> CITY CLERK PROCESSING FORM °E ��FF <br /> . , . Agreements /Amendments / Extensions / Deeds <br /> REVIVE FUNDED? COVID FUNDED? CONFIDENTIAL? <br /> OYES ❑■ NO OYES ❑■ NO ❑YES ❑■ NO <br /> TO: CITY CLERK'S OFFICE <br /> FROM: DEPT.: PWA / Water Resources MAIL STOP: M-85 <br /> PROJECT MANAGER: Leif Lovegren EXT.: 3327 <br /> The following information 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 this form) <br /> NAME OF CONSULTANT/PARTY: BIG BEN, INC. <br /> AGREEMENT NUMBER(if applicable): A / N A-2024-165-03 <br /> AMENDMENT NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑4TH <br /> (if applicable) : <br /> EXTENSION NUMBER ❑ 1ST 0 2ND ❑ 3RD ❑4TH <br /> (if applicable): <br /> An amendment/extension requires a copy of a Staff Report and/or initial agreement to be included. <br /> AMOUNT: OVER ❑ * $50,000 *Note: Council approval is required if an agreement with a <br /> At* <br /> 0,000 AND UNDER vendor exceeds $50,000 within a Fiscal Year for non- <br /> public works agreements. <br /> Bid for contracts exceeding $50.000. will continue to require <br /> a formal Invitation for Bid, <br /> ❑■ 1) Approved by council. ❑ 2) NOT approved by council. <br /> COUNCIL APPROVAL DATE: 10/15/24 ITEM#: 15 <br /> TERM OF AGREEMENT EFFECTIVE DATE: 10/15/24 TERMINATION DATE: 10/14/27 <br /> SIGNATURES REQUIRED: ❑ VENDOR ❑ AGENCY ❑ CITY ATTORNEY . I OTHER <br /> NOTARIZATION REQUIRED ❑ YES NO <br /> APPROVED INSURANCE: ❑ YES X NO <br /> (INSURANCE APPROVAL REQUIRED BY RISK INIGMT. PRIOR TO SUBMITTING TO CITY CLERK) <br /> COMMENTS: <br /> CCI►I -(c. r p;c-ih u p X 5Gt <br /> FOR CLERK OFFICE USE ONLY: 0 PROCESS 0 DO NOT PROCESS <br /> ❑ Missing Signatures 0 Needs Council Approval ❑ Other <br /> ADDITIONAL REMARKS: 1h50 ranC> <br /> *Effective July 6, 2023, City Manager contract authority increased via Ordinance NS-3041. <br /> I:IAgreements\Forms\Form-AGREEMENT PROCESSING FORM-06-19-2023-FINAL,doc Revised:06/19/2023 <br /> Page 1 of 2 <br />