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2. Date
   Date
4. Contracting Agency
6. Project
8. Department/Division
10. Contact
11. Phone
13. Explanation/Reason for Agreement
15. Please verify and check off the following boxes before submitting it for routing.
17. Contract Is For

    1. Goods
    2. Public Improvement/Construction
    3. Services
19. Preliminary Review by Attorney's Office

    1. Yes
20. Name
22. Minimum of 2 Original Copies of Agreement

    1. Yes
24. Does the Agreement Include the Following

    1. Address/Phone Number of Contracting Agency
    2. All Exhibits (Including Scope of Service)
    3. Indemnification/Hold Harmless Agreement
    4. Initials of Department Director/Division Manager

    1. Insurance/Worker's Compensation Provisions/Certificates
    2. Notice of Award
    3. Original Signature of Contracting Agency
    4. Performance/Payment Bond
26. Purchasing Procedures

    1. Competitively Bid
    2. Sole Source (Signed Authorization Must Be Attached)

    1. Telephone Quotes
    2. Other
28. Agreement Requires Expenditure of Funds

    1. Yes
29. Budget Account Number
31. Amends Previously Approved Agreement

    1. Yes
32. Agreement Identifying Number
34. Agreement Will Use Grant Funding

    1. Yes
35. Indicate Agency
37. Document Upload
41. To avoid delays in routing, please ensure all required information has been included as indicated.
43. Recorder's Office Initials
44. Date
    Date
46. Administrative Service Director Initials
47. Date
    Date
49. Attorney's Office Final Review Initials
50. Date
    Date
52. City Manager Initials
53. Date
    Date
55. City Council (If Applicable) Initials
56. Date
    Date
58. Mayor Initials
59. Date
    Date
61. Recorder's Office - Attesting
62. Date
    Date
64. Identifying Number
66. Additional Agreements/Copies Returned
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field