CM-05-01-010Request for City Council/City Manager Action
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Please submit this form when placing items on the council agenda or when submitting an item to the City Manager for approval.
Department: Legal Project Manager/Resource: Bill Stablein
Contact Person: Steve Sheets/Laura Levinson
Project Name: Highway 79 Improvements
Contractor/Vendor Name: N/A
Council Meeting Date: N/A
Funding Source:
Assigned Attorney:
4B Funds
Don Childs
Amount: $5,000.00 (contract, agreement,amendmchange order, purchase order,etc.)
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Is Funding Required? Yes
Council Agenda Item Yes
X
No
No
Submission to City Manager - Yes X No
X
(see required signatures below before submission to the City Manager)
Agenda Wording:
▪ Initial Construction Contract
ElConstruction Contract Amendment
▪ Change Order
n Change in Quantity
n Unforeseen Circumstances
▪ Initial Professional Services Agreement
▪ Supplemental Professional Svcs. Agr.
▪ Purchasing/Service Agreement
ElPurchase Order
Item(s) to be purchased:
X❑
Amount
Other (Please clearly identify action on lines below) $5,000.00
City Manager to ececute a real estate contract for the purchase of 0.0219 acres
from Edwin Clark for Highway 79 Improvements. (Parcel 12).
Cc i
For Submission to Cit Man er On!
Project Mgr. Signature: ( A .4 01P
Dept. Director Signature:
City Attorney Signature:
City Manager Signature:
Date: r7- cj
Date:
Date:
Date:
Legal Approval is required for all items requesting City Manager's approval.
Finance Approval
E lFinance -Date and Signature: 1-26-05 L. Olsen
▪ Purchasing -Date and Signature:
X❑ Budget -Date and Signature: N/A ESW 1/26/05