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COTC PROCESSING FORM 4CIFr,Prvir <br />Agreements / Amendments / Deeds! OCT 1 <br />5,13 <br />CITY OF SANTA ANA <br />TO: CLERK OF THE COUNCIL OFFICE CLERK OF COUNCIL <br />FROM: DEPT.: Finance MAIL STOP: M-83 <br />PROJECT MANAGER: Chris Laucenour EXT.: 0361 <br />AGREEMENT NUMBER (if amendment): A / N <br />AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND ® 3RD ❑ <br />NAME OF CONSULTANT / PARTY: Rose Equipment Repair <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 />Ej 1) NOT approved by council. <br />[:12) Approved by council. <br />COUNCIL APPROVAL DATE: October 4, 2016 ITEM #: <br />TERM OF AGREEMENT- EFFECTIVE DATE: <br />10/4/16 <br />25-H <br />TERMINATION DATE., <br />SIGNATURES REQUIRED: VENDOR ® AGENCY <br />H CITY ATTORNEY ❑ OTHER <br />10/3/19 <br />(INSURANCEAPPROVAL REQUIRED BY CAO PRIOR TO SUBMITTING TO COTC) <br />INSURANCE REQUIRED: 0 YES ® NO (Provide City Attorney Office approval) <br />❑ AUTO ❑ CGL (Commercial General Liability) <br />❑ PROFESSIONAL LIABILITY ❑ WORKERS COMPENSATION <br />COMMENTS: <br />* Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS -2717 <br />I:IAgreements\Form -AGREEMENT PROCESSING FORM_canary.doc <br />Revised: 1/17/2012 <br />