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13-1001_RAFTELIS FINANCIAL CONSULTANT, INC._Document TransmittalCITY OF SAN JUAN CAPISTRANO DOCUMENT TRANSMIT This form is for the transmittal of docur (e.g. Agreements, Contracts, Deed City Council, SJCHA or SACRA Meeting Date (if applicable): Brief description of document and/or services prov Submitting Department: Please sign each original of the attached document, where .indicated and circulate in the below route order as applicable (Please note the procurement limitations below). When the document is fully executed, the City Clerk will provide a signed copy to the submitting department and to the Financial Services Department (when applicable), and will mail a signed original to the contractor/consultant. Step 1 ❑ Purchasing — For Procurement Contracts/Agreements (if applicable) ❑ $3,000 or less —(Department Head's Aulhority- No Purchase Order Required STOP -further rouling not necessar)) ❑ $3,001 - $10,000 — (Department Head's Authority) R1 0,00 1 - $45,000 — (Cily Manager's Authority) $45,001 or over — (City Council Approval Required*) *Date of Council Approval: (� I or Resolution. No. 0 Public Contracts $45,000 or less — (City Manager's Authoriq, Required) ❑ Public Contracts over $45,000 — (City Council's Aulhority Required*) *Date of Council Approval: or Resolution. No.: Step 2 L1 Department Head I1. J Approved Q Not Approved (� Not Applicable�(n Director's Initials/Date )7, Step 3 ❑ City Attorlta,Jy Q Approved ❑ Not Approved ❑ Not Applicable City Attorney's Initials/Date Step 4 ❑ Finance = Funding Available ❑ No Funding Available 0 Budget Amendment Required Notes: Finance Initials/Date Step 5 ❑ City Manager Froved iedager's Initial's/Date: Step 6 E:�fnsuranee Requirements (if applicable) *Mark the requirements included in the attached document. F=Prublic ercial/General Liability6V__ 0 tttonal Insured Endors ene�n �t�iability Worker's Compensation l/„ l ional/Errors and Omissions Not Applicable Works Contracts —Labor/Material &Performance Bonds Step 7 U City Clerk (For Final Routing) Iv l Approval Process Completed — Copy of Contract Transmittal Form with documents forwarded to FS Department or back to the originating department as appropriate. 0 Denied — Rftumed to submitter c�eparlment. Please provide the following and return to the City Clerk's Office: City Clerk' Page 1 of 2 1. Contractor/Consultant Name: V a�' 1 t S 2. Business License*: ❑ Yes [�No License Number: Date of Expiration *If work is performed in the City, a Business License is required. j+p 1' �l/ t L EL 3. Contract Amount: $ 4. Budget Account Number: 6 D— � LiS73 O 66 I Oe-4 — ©ore)© 6O p 5. City SW'd Facilities to be provided (If Applicable): 6. Is this a standard City contract? EWes ❑ No If no, explain: 7. Are two original contracts submitted? Yes ❑ No If no, explain: 8. Contract Date: Iri� I ZI � Expiration Date: & / Lq 9. Insurance Certificate (f applicable) attached: 52'YeS ❑ No If no, explain: 10. Purchase (f applicable) Requisition attached: Yes ❑ No If no, explain: 11. Bid Recap if, pplicable) ttached: Yes Q Io If no, explain: 12. W�-9 For(if applica le) a hed: ❑ Ye []moo If no,plai 13. New Vendor Application Form (f applicable) attached: ❑ Yes No If no, explain: 14. Does this document need to be recorded? ❑ Yes [2'<o If Yes, please provide only one original copy. The Financial Services Department will issue a Purchase Order (PO) to the submitting department, once all of the information on this Contract Transmittal Form has been received by finance through the City Clerk's Office. Page 2 of 2