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aca[on =st <br />„ "1 :11- 4x, <br />CHLCKLIST KOR PROCESSING AGREEMENTS ANDIDMENTS <br />TO: CLERK OF THE COUNCIL "OFFICE <br />FROM: DEPT.: pe -K )1' ne] se_ryl /[,E MAIL STOP' nZ <br />CONTACT PERSON:( &� EXT.: '5 35� <br />THE FOLLOWING ITEMS SHOULD BE PROVIDED IN REQUESTING PROCESSING OF AGREEMENTS FOR THE CITY: <br />AGREEMENT NUMBER (if amendment): A /IN/ ADO ('lob <br />u <br />AMENDMENT NUMBER (if applicable): 1ST El 2ND ❑ 3RD ❑ <br />COUNCIL APPROVAL DATE: N 1N j <br />AMOUNT ❑OVER $10,000 �7 <br />NAME OF CONSULTANT' Y uaw Ck f <br />TERM OF AGREEMENT: EFFECTIVE DATE: <br />INSURANCE REQUIRED: ❑ NO <br />DER $10,000 <br />TERMINATION DATE: (e'..y )✓ U✓ <br />YES If yes, ATTACHED ❑ IN PROGRESS <br />AUTO j�( CGL (Commercial General Liability) <br />❑ PROFESSIONAL LIABILITY K WORKERS COMPENSATION <br />(INS. APPROVAL REQUIRED BY CAO PRIOR TO SUBMITTING TO COTC) <br />SIGNATURES REQUIRED: <br />❑ VENDOR ❑ AGENCY (UNDER $10,000) <br />❑ CITYATTORNEY ❑ OTHER <br />FOR <br />USE ONLY: <br />V PROCESS 13 DO NOT PROCESS <br />• MISSING SIGNATURES <br />• NEEDS COUNCIL APPROVAL <br />/ <br />[I OTHER <br />ADDITIONAL REMARKS: �J % - "9_d, �,IJJ �JI,2"P <br />