CM-05-02-023Cm-OS-Oa-oa3
Request for City Council/City Manager Action IwopRIN �AII {�y} tq'A
Please submit this form when placing items on the council agenda or when submitting an item to the City Manager for approve "' "" "�
Department: EDS/Legal Project Manager/Resource: Eric Langhout
Contact Person: Latha (J. Kay Gayle)
Project Name: N/A
ContractorNendor Name: Wal-Mart
Amount: N/A
Is Funding Required?
Council Agenda Item
Submission to City Manager -
Yes No
Yes
No
Yes x No
x
x
Council Meeting Date: N/A
Funding Source: N/A
Assigned Attorney: J. Kay Gayle
(contract, agreement,amendment,change order, purchase order,etc.)
(see required signatures below before submission to the City Manager)
0
Initial Construction Contract
❑ Construction Contract Amendment #
❑ Change Order
r Change in Quantity
n Unforeseen Circumstances
❑ Initial Professional Services Agreement
❑ Supplemental Professional Svcs. Agr. #
❑ Purchasing/Service Agreement
❑ Purchase Order
Item(s) to be purchased:
Amount
ElOther (Please clearly identify action on lines below)
Four (4) easements from Wal-Mart to City of Round Rock
Agenda Wording: Authorization for City Manager to counter -sign four easements
executed by Wal-Mart to the City.
`1-0S Rios n 't'o 'Rah (Ire d
for r morel I r
c c lat a a Eic)L 1'r t)
For Submission to Cit Mana er Onl
Project Mgr. Signature:
Dept. Director Signature:
City Attorney Signature: *
City Manager Signature:
I•••••••r
P -E
Date:
Date:
Date:
Date:
2-2. )S
pproval is required for all items requesting City Manager's approval.
Finance Approval X❑ Finance -Date and Signature: E. Wilson 2/1/05
X❑ Purchasing -Date and Signature: N/A HB 01-31-05
X❑ Budget -Date and Signature: N/A CYD 1-31-05
g/administraton/cmgr-council action.xls 11-1-04