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COTC PROCESSING FORM <br />Agreements / Amendments / Deeds 2DI6 CCT 3 I AM 1i- 42 <br />.CITY OF SANTA ANIA <br />TO: CLERK OF THE COUNCIL OFFICE CLERK OF t,(14AUL <br />FROM: DEPT.: Design Engineering <br />MAIL STOP: M-36 <br />PROJECT MANAGER: Mindy LV " ' "AEX1 , 5665 <br />AGREEMENT NUMBER (if amendment): A / N <br />AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND ❑ 3RD ❑ <br />NAME OF CONSULTANT / PARTY: Benjamin Lopez JR. - P&S Agreement ($11,100.00) / NOTARY <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: 10/18/16 ITEM #: <br />TERM OF AGREEMENT <br />SIGNATURES REQUIRED: <br />EFFECTIVE DATE: <br />10/18/16 <br />TERMINATION DATE: <br />❑ VENDOR © AGENCY <br />❑ CITY ATTORNEY ❑ OTHER <br />n/a <br />(INSURANCE APPROVAL REQUIRED BY CAO 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: Please contact Mona Iskandar for pickup X5013 or miskandar@santa-ana.org <br />FOR CLERK OFFICE USE ONLY: ❑ PROCESS ❑ DO NOT PROCESS <br />❑ Needs Council Approval <br />❑ Missing Signatures <br />❑ Other <br />ADDITIONAL REMARKS: <br />* Charter amendment effective December 21, 2006 for City Manager contract authority increase; NS -2717 <br />1:1AgreementslForm -AGREEMENT PROCESSING FORM_canary.doc <br />Revised, 1/17/2012 <br />