Laserfiche WebLink
CITY CLERK <br />n• J _mK <br />PROCESSING FORM �ll28 917P.H8 r6 <br />Agreements / Amendments / Extensions / Deeds <br />REVIVE FUNDED? <br />COVID FUNDED? <br />CONFIDENTIAL? <br />❑YES X NO <br />❑YES N NO <br />El YES NO <br />USH <br />TO: <br />CITY CLERK'S OFFICE <br />FROM: DEPT.: Public Works - Traffic Engineering MAIL STOP: M-43 <br />PROJECT MANAGER: Ruben CaStaneda EXT.: 5621 <br />The following information must be provided 1 <br />in requesting processing of agreements / amendments / extensions / deeds for the C ity: <br />(See page 2 for instructions on how to fill out the this form) <br />NAME OF CONSULTANT / PARTY: Statewide Traffic Safety and Signs <br />AGREEMENT NUMBER (if applicable): A / N A-2022-013-01{N <br />AMENDMENT NUMBER ❑ 1ST ❑ 2ND ❑ 3RD ❑ 4TH <br />(if applicable) : <br />EXTENSION NUMBER N 1ST ❑ 2ND ❑ 3RD ❑ 4TH <br />(if applicable): <br />An amendmentlextension requires a copy of a Staff Report and/or initial agreement to be included. <br />AMOUNT: ❑ * OVER N * $50,000 `Note: Council approval is required if an agreement with a <br />$50,000 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 reauire <br />a formal Invitation for Bid. <br />❑ 1) Approved by council. 0 2) NOT approved by council. <br />COUNCIL APPROVAL DATE: <br />ITEM #: <br />TERM OF AGREEMENT EFFECTIVE DATE: 02/01/2025 TERMINATION DATE: 01/31/2027 <br />SIGNATURES REQUIRED: K VENDOR ❑p AGENCY <br />NOTARIZATION REQUIRED ❑ YES <br />APPROVED INSURANCE: X YES <br />❑p CITY ATTORNEY ❑ OTHER <br />F NO <br />❑ NO <br />(IIN�SUR'ANCE APPROVAL REQUIREDBY RISK MGMT- PRIOR TO SUFBMIET'TIIN'G TO CITY CLERK) <br />COMMENTS: Please sign the attached Extension of Agreement, I've attached a copy of the original current agreement that expires on 01/31/25. <br />Please return fully executed copies to Keri Buck Mail Stop M-43 <br />FOR CLERK OFFICE USE ONLY: <br />❑ Missing Signatures <br />ADDITIONAL REMARKS: <br />0 PROCESS O DO NOT PROCESS <br />❑ Needs Council Approval ❑ Other <br />-tttective duly b, ZUZ3, City manager contract authority increased via Ordinance NS-3041. <br />hAgreemenlsWormslForm -AGREEMENT PROCESSING FORM-06-19-2023-FINAL.doc Revised: 06/19/2023 <br />Page 1 of 2 <br />