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COTC PROCESSING FORM CtearForm <br />Agreements / Amendments / Deeds <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT Police Department MAIL STOP M-18 <br />PROJECT MANAGER Ofcr. Otto Laufer EXT <br />The foilowing information must be provided <br />in requesting processing of agreements /amendments / deeds for the City: <br />AGREEMENT NUMBER of amendment) A + N NIA <br />AMENDMENT NUMBER (if applicable) ❑ IST M 2ND 8 3RD <br />NAME OF CONSULTANT / PARTY General Services Administration (GSA) <br />AMOUNT: ❑ " OVER $25.000 - (A) ❑ *UP TO $25.000 (N) r4')t ' <br />.ev b v <br />afi]rCax: <br />COUNCIL APPROVAL DATE: N/A ITEM #: <br />TERM OF AGREEMENT- EFFECTIVE DATE: 02/0112016 TERMINATION DATE: 04/30/2018 <br />SIGNATURES REQUIRED: VENDOR ❑ AGENCY <br />H CITY ATTORNEY OTHER <br />(INSURANCE APPROVAL REQUIRED BY CAO PRIOR TO SUBMITTING TO COTC) <br />INSURANCE REQUIRED: ❑ YES ® NO (Provide City Attorney Office approval) <br />❑ AUTO ❑ COL (Commercial General Liability) <br />Q PROFESSIONAL LIABILITY ❑ WORKERS COMPENSATION <br />COMMENTS: Request City Manager's authorization/signature to execute attached Revocable License <br />for Non -Federal Use of Real PrDDerty (Ronald Reagan Federal Courthouse). This License is for the sole purpose <br />of allowing the Police Department to install infrastructure on the courthouse roof for our Citv-wide Camera Svstem. <br />0 Needs Council Approval <br />0 Missing Signatures <br />C1 /Other- <br />ADDITIONAL <br />ther n L <br />ADDITIONAL REMARKS: �� � %/`"j�,'i <br />V O A /J rhU/ A <br />Gnaner amendmew eirective i.>ecernver 21, 20U6 for („Ily Manager contract authority increase- NS=171 7 <br />1{+q'acmrnLr Flm Ac;RH Wil' ngr3GE7. )xwy ax <br />Gwidl 1 i' 40,+.2 <br />