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COTC PROCESSING FORM <br />Agreements / Amendments / Deeds ang = c i{ <br />f;ITY 0 F rZ=A <br />1 <br />C) -.. <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: PWA Design Engineering <br />PROJECT MANAGER: Jason Gabriel (Leticia LODez) kn <br />MAIL STOP: M-36 <br />EXT.: 5013 <br />AGREEMENT NUMBER (if amendment): A / N <br />AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND R 3RD ❑ <br />NAME OF CONSULTANT/ PARTY: PSA - DAT NGOC HOANG <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: 2/20/18 ITEM #: <br />TERM OF AGREEMENT- EFFECTIVE DATE: 2/20/18 TERMINATION DATE: <br />SIGNATURES REQUIRED: m VENDOR ® AGENCY <br />® CITYATTORNEY ®OTHER <br />25E <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 Leticia x5013 for pick-up n <br />ONLY: ❑ 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 />1: 1AgreementslForm -AGREEMENT PROCESSING FORM_canary.doc <br />Revised: 1/17/2012 <br />