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COTC PROCESSING FORM <br />I Agreements / Amendments / Deeds <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: DEVELOPMENT ENGINEERING <br />N- 2013 -155 <br />2L1;3 NOV _7 Ail 9: 9 <br />rva y <br />ANA <br />`G <br />(i. <br />MAIL STOP: M -93 <br />PROJECT MANAGER: ANDERSON CHRYSOSTOMO EXT.: 5838 <br />AGREEMENT NUMBER (if amendment): A / N NA <br />AMENDMENT NUMBER (if applicable): ❑ 1 ST ❑ 2ND ❑ 3RD ❑ <br />NAME OF CONSULTANT/ PARTY: HOUSING AUTHORITY OF THE CITY OF SANTA ANA <br />AMOUNT: ❑ OVER $25,000 — (A) ❑ *UP TO $25,000 - (N) Note: If your agreement with a vendor exceeds $25,000 <br />within a Fiscal Year, then you will need to obtain Council <br />Approval. <br />❑ 1) NOT approved by council. <br />❑ 2) Approved by Council. <br />COUNCIL APPROVAL DATE: NA ITEM #: <br />TERM OF AGREEMENT- EFFECTIVE DATE: <br />TERMINATION DA TIE, <br />SIGNATURES REQUIRED: ❑ VENDOR ❑ AGENCY <br />❑ CITYATTORNEY n,/ OTHER <br />(INSURANCE APPROVAL REQUIRED BY GAO PRIOR TO SUBMITTING TO COTC) <br />INSURANCE REQUIRED: ❑ YES NO (Provide City Attorney Office approval) <br />❑ AUTO ❑ CGL (Commercial General Liability) <br />❑ PROFESSIONAL LIABILITY ❑ WORKERS COMPENSATION <br />COMMENTS: SIGNATURE BY CITY MANAGER AND CITY CLERK ON CERTIFICATE OF <br />ACCEPTANCE FOR STREET EASEMENT. <br />❑ PROCESS ❑ DO NOT PROCESS <br />❑ Needs Council Approval <br />• Missing Signatures <br />• Other <br />* Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS -2717 <br />I:IAgreementsftrm - AGREEMENT PROCESSING FORM_canary.doc <br />Revised: 111712012 <br />