CM-05-03-049I ort) Cm- 05-03.00
Request for City Council/City Manager Action RECD MAR 1 0 ZOOS
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: RM 620 Box Culvert
ContractorNendor Name: Paul Hornsby & Company
Council Meeting Date: N/A
Funding Source: Regional Detention Funds
Assigned Attorney:
Steve Sheets/Laura Levinson
Amount: $6,425.00 (contract, agreement,amendment,change order, purchase order,etc.)
Is Funding Required?
Council Agenda Item
Submission to City Manager -
Yes X No
Yes
No
Yes X No
X
5 (� -o5 12 n +o Late-
-C: LApv>n
(see required signatures below before submission to the City Manager)
Amount
Initial Construction Contract
▪ Construction Contract Amendment #_
ElChange Order
17Change in Quantity
n Unforeseen Circumstances
XD Initial Professional Services Agreement $6,425.00
ElSupplemental Professional Svcs. Agr. #
▪ Purchasing/Service Agreement
❑ Purchase Order
Item(s) to be purchased:
❑ Other (Please clearly identify action on lines below)
Agenda Wording: Authorization for the City Manager to sign an engagement letter with Paul Hornsby
& Company for appraisal services for drainage easements for RM 620 Box Culvert.
For Submission to Cit M ager OnI
Project Mgr. Signature:
Dept. Director Signature:
City Attorney Signature:
City Manager Signature:
Date: 3.1
%� 1 Date:
. • J Date: 3 - 7-05
Date: 3- is -o
* Approval is required for all items requesting City Manager's approval.
Finance Approval x❑ Finance -Date and Signature: 2-23-05 L. Olsen
❑ Purchasing -Date and Signature: