HomeMy WebLinkAboutChecklist Documents0,k 0. . City Clerk's Division Date Stamp) Contract Number:
Assigned by Clerk Staff)
y CHECKLIST FOR LIST HERE IE PREVIOUSLY ASSIGNED
4'NTo NEW CONTRACTS 1(612
Please return to the City Clerk's Division View Policy 250-02 for more information***
SPECIFICATIONS OF CONTRACT
TYPE OF DOCUMENT: 0 Contract/Agreement 0 Lease 0 Permit 0 New Job Order Contract Work Order
Contractor Name: U.S. Department of Justice, Drug Enforcement Administration (DEA)
Agreement Description: Se._ 20— 3 S`1 liQc^rc
Brief explanation of services provided)
I CONTACT INFORMATION D-C) I DE v 1
Signing Authority: Cit-\( ..Jc _.._, ._-__, -- II Approved/Reviewed by Administrator
This is the name of the person(s)signing the contract
Staff Name & Ext.: Melissa Day, x7507 Dept./Division: Police/Administration
The name of the person who will receive the completed contract
I EXPIRATION DATE:N/A 1 Z._31 _ 01 I
DATE MUST MATCH DATE IN CONTRACT!!If no actual date,please provide estimate—information is required by Eden.
FISCAL IMP ACT
AGREEMENT CLASS: °Payable,Vendor#: 0 Receivable 0 Grant 0 Misc. (no$$)
TOTAL AMOUNT OF THIS AGREEMENT:
if applicable) Retainage Withheld: i Yes If Yes, 0 No If No,
ITEMS TO INCLUDE/SUBMIT
2 Signed Originals OR I 1 Signed Original Insurance Info (not for WO) _ '.egal Review
You will receive one signed You will receive an electronic
orig.back) copy back via email)Risk Management Review
Performance Bond Verification Memo (if applicable) Federal Excluded Parties List Verification
9/2 /2020 Federal Funded Projects Only)
Date of Council Approval (if applicable) Corresponding ORD or RES#:
please enter CAG number at tap if contract has a previously assigned number)
1 FOR CLERKS OFFICE USE ONLY
X Cindy Deputy Approved: Cindy 9/24/2020
Vendor# no needed
Sandi Mayor's Signature ded: X Yes No X Att pr val
Date Cor pleted/Return . 9/ 2020 3' Sig Authori Correct
nic pi Print X Ins Info Current/Provided
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