CM-05-02-026Cm -os -tea - oaq
Request for City Council/City Manager Action kelt, MI5
Please submit this form when placing items on the council agenda or when submitting an item to the City Managerfffo�rr approva M
Department:
Contact Person:
Project Name:
EDS/Legal
Latha (J. Kay Gayle)
N/A
ContractorNendor Name: Wal-Mart
Amount: N/A (contract, agreement,amendment,change order, purchase order,etc.)
Project Manager/Resource: Eric Langhout
Council Meeting Date: N/A
Funding Source: N/A
Assigned Attorney: J. Kay Gayle
Is Funding Required? Yes
Council Agenda Item Yes
Submission to City Manager - Yes
x
No
No
No
x
x
(see required signatures below before submission to the City Manager)
Agenda Wording:
Initial Construction Contract
▪ Construction Contract Amendment
Change Order
n Change in Quantity
El Unforeseen Circumstances
• Initial Professional Services Agreement
O Supplemental Professional Svcs. Agr. #
• Purchasing/Service Agreement
▪ Purchase Order
Item(s) to be purchased:
Amount
QOther (Please clearly identify action on lines below)
Four (4) easements from Wal-Mart to City of Round Rock
Authorization for City Manager to counter -sign four easements
a 05 Return -to P fi1 (!ec &i)
Or reeord i vi J
ec : %A -alar �0.At
executed by Wal-Mart to the City.
For Submission to Ci
Project Mgr. Signature:
Dept. Director Signature:
amity Attorney Signature:
amity Manager Signature:
Mana • er On!
Date:
Date:
Date:
Date:
2-ioS.
aIWpproval is required for all items requesting City Manager's approval.
Finance Approval El
a
Finance -Date and Signature:
Purchasing -Date and Signature:
Budget -Date and Signature:
E. Wilson 2/1/05
N/A
HB 01-31-05
N/ACYD 1-31-05
yadministrationlangr-count acignxls 11-1-04