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COTC PROCESSING FORM <br />Agreements / Amendments / Deeds".' <br />TO: CLERK OF THE COUNCIL OFFICE <br />FROM: DEPT.: Personnel <br />PROJECT MANAGER: Carrie Hanes <br />MAIL STOP: <br />AGREEMENT NUMBER (if amendment): A / N --Z�ce) \ q 0-1— `> <br />AMENDMENT NUMBER (if applicable): ❑ 1ST ❑ 2ND ❑ 3RD ❑ <br />NAME OF CONSULTANT/ PARTY: Met Life Dental <br />24 <br />EXT.: 6967 <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 />0 2) Approved by council. <br />COUNCIL APPROVAL DATE: 2/6/18 ITEM #: <br />25C <br />TERM OF AGREEMENT- EFFECTIVE DATE: January 1, 2018 TERMINATION DATE: <br />SIGNATURES REQUIRED: ❑ VENDOR 0 AGENCY <br />❑ CITY ATTORNEY ❑ OTHER <br />December 31, 2019 <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: <br />FOR CLERK OFFICE USE ONLY: <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:LAgreementsVorm -AGREEMENT PROCESSING FORM_canary.doc <br />Revised: 1/17/2012 <br />