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<br />/V,itUUb -1;( 7 <br /> <br />, <br />CHECKLIST FOR PROCESSING AGREEMENTS AND AMENDM~TS <br /> <br /> <br />~, <br />,/'" <br />('I: II <br />, '(~"I <br />a'J..' <br /> <br />TO: CLERK OF THE COUNCIL OFFICE <br /> <br />FROM: DEPT.: r'~vi4- /U/zler ItwvrrtpJ <br />I <br />CONTACT PERSON: 7:::ty> I! IX <br /> <br />MAIL STOP: //4' !Ji;- <br />55:; / <br />EXT.: (0 <br /> <br />THE FOLLOWING ITEMS SHOULD BE PROVIDED IN REQUESTING PROCESSING OF AGREEMENTS FOR THE CITY: <br /> <br />AGREEMENT NUMBER (il amendment): A I N <br /> <br /> <br />AMENDMENT NUMBER (il appiiGable): <br /> <br /> <br />COUNCIL APPROVAL DATE: 1//0 <br /> <br />AMOUNT: 0 OVER$10,OOO <br />NAME OF CONSULTANT: J;{",'l:{.j w;; i-r <br />TERM OF AGREEMENT: EFFEC~IVE DATE: 7/ /cJ {; <br />, <br /> <br />o 1 ST 0 2ND 0 3RD <br />tv",>,""! ;Jehu", /tWlfed <br />/ <br />'El UNDER $10,000 <br />" - c.L.. CtJi/ PI. /f1 ft/ /J t'C <br />TERMINATION DATE: ;2;;'/~; 7 <br />I / <br /> <br />o <br /> <br /> <br />INSURANCE REQUIRED: )21' NO <br />DYES <br /> <br />II yes, 0 ATTACHED <br /> <br />o IN PROGRESS <br /> <br />o AUTO <br />o PROFESSIONAL LIABILITY <br /> <br />o CGL (Commercial General Liability) <br />o WORKERS COMPENSATION <br /> <br />(INS. APPROVAL REQUIRED BY CAO PRIOR TO SUBMITTING TO COTC) <br /> <br />SIGNATURES REQUIRED: <br />o VENDOR <br />o CITY ATTORNEY <br /> <br />o <br />o <br /> <br />AGENCY (UNDER $10,000) <br />OTHER <br /> <br />COMMENTS: <br /> <br />,"1, <br />{Up <br /> <br />!) 0 <br /> <br />WlI:{./~4' <br /> <br />d <br /> <br />"1+'-"'1l <br /> <br />~~ <br /> <br />&#,[ <br /> <br />h <br /> <br /> <br />/ <br />iva /c'r- <br /> <br /> <br />('.)L,/'-i'4'J <br /> <br />fi1 w!J (!{ <br /> <br /> <br />.< <br /> <br />FOR CLER'Y>>'FICE USE ONLY: <br />W PROCESS <br /> <br />o <br /> <br />DO NOT PROCESS <br />o MISSING SIGNATURES <br />o NEEDS COUNCIL APPROVAL <br />o OTHER <br /> <br />ADDITIONAL REMARKS: <br /> <br />C.\Dc"umentD and SeUings\r,milrD\Lccal S6\lings\Tempnrary !ntomet F:IE)'J\OLKC!'hFnrm ~ AGREEMENT PROCESS1NG REQUEST FORM - olr'ilry,do<,. <br />