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Home My WebLink AboutSea View Homes Delaware - Bijan Sassounian - Reimbursement A R REQUE:. . FOR CITY COUNC ACTION Date November 5, 1990 Submitted to: Honorable Mayor and City Council Submitted by: Michael T. Uberuaga, City Administrator Prepared by: Louis F. Sandoval, Director of Public Works Qm. Subject: REIMBURSEMENT AGREEMENT 90-Wl (B. SASSOUNIAN) Consistent with Council Policy? [X] Yes [ ] New Policy or Exception Statement of Issue, Recommendation,Analysis, Funding Source,Alternative Actions,Attachments: STATEMENT OF ISSUE: Bijan Sassounian seeks approval of Reimbursement Agreement 90-Wl for the oversizing of sixty-seven ( 67 ) lineal feet of water main he constructed in Delaware Street. RECOMMENDATION: Approve Reimbursement Agreement 90-Wl which establishes a reimbursement to Bijan Sassounian in the amount of $2, 354.00. ANALYSIS: Bijan Sassounian, at his own expense, constructed sixty-seven ( 67 ) lineal feet of water main in Delaware Street to serve his development, located on the southwest corner of Memphis Avenue and Delaware Street. At the request of the Water Division, a twelve inch water main was installed in lieu of the eight inch size needed to serve the development. The oversizing was deemed necessary by the Water Operations Manager to best serve the interests of the City Water System. The twelve inch main will be extended southerly to Indianapolis Avenue at a later date. Municipal Code Sections 14.20 .050 and 14.20 . 060 provide a method of reimbursement to the applicant for the difference in costs between the size of main necessary to serve the development and the oversized main. In accordance with those Code Sections, reimbursement would normally be made from fees derived from subsequent developments . Since no other developments will directly connect to this main, however, the Water Division agreed to reimburse the applicant from the water fund because the main is considered to be ultimately necessary for the water system. Therefore, it is recommended that the developer, Bijan Sassounian, be reimbursed $2, 354. 00 for the construction cost differential P10 5/85 r f Eric Charlonne FROM DATE ❑ FOR YOUR INFO ❑ NOTE AND RETURN PLEASE HANDLE ❑ NOTE AND FILE ❑ PLEASE ANSWER ❑ NOTE AND CIRCULATE ❑ PLEASE SEE ME C7 PREPARE FOR MY SIGNATURE ❑ INITIAL AND RETURN ❑ FOR YOUR REVIEW AND COMMENTS ❑ PER YOUR REQUEST ❑ NOTICE SENT. REQUEST ANSWER COMMENTS: R,6- +� �,� f;�K, RelK 1 .. ` Page two RCA - Reimbursement agreement 90-Wl (B. Sassounian) November 5, 1990 caused by the oversizing of the water main from eight inch to twelve - inch. The installation has been constructed to the satisfaction of the Director of Public Works and all costs have been checked and certified. Reimbursement Agreement 90-Wl has been prepared to facilitate the reimbursement. FUNDING SOURCE: Sufficient funds of $2 , 354. 00 are available in the 90/91 Fiscal Account E-EW-PW-921-6-39-00 . ALTERNATIVE ACTION: 1 . Do not reimburse. This option would require the developer to fund the oversized water main improvements. 2 . Direct staff to proceed with an alternative plan for reimbursement. ATTACHMENTS: 1 . Location Map 2 . Reimbursement Agreement 90-W1 . LFS :JRR: EC: bb RCA/90-W1 i REIMBURSEMENT AGREEMENT 90-W1 FOR WATER MAIN CONSTRUCTION BETWEEN THE CITY OF HUNTINGTON BEACH AND SEA VIEW HOMES DELAWARE THIS AGREEMENT is made and entered into on this day of 1990, by and between the CITY OF HUNTINGTON BEACH, a municipal corporation of the State of California, hereinafter referred to as "CITY, " and SEA VIEW HOMES DELAWARE, a California unlimited partnership, hereinafter .e referred to as "BUILDER. " '- WHEREAS, BUILDER has at its own cost and expense installed water main improvements, hereinafter referred to as "FACILITIES, " for the benefit of the construction project at 1217 and 1219 Delaware Street in the City of Huntington Beach; and PURSUANT to Chapter 99 of the Huntington Beach Ordinance Code (HBOC) , FACILITIES contain supplemental size, capacity or number for the benefit of property not within BUILDER' s project; and FACILITIES have been constructed in conformance with plans and specifications approved by CITY' s Director of Public Works and have been duly dedicated to CITY, and consist of a twelve-inch water main system; and . Attached hereto as Exhibit "A, " and by this reference made a part hereof, is a map depicting FACILITIES and the area thereby served; and FACILITIES have been constructed in such manner as to provide a system of four inches supplemental capacity; and -1- In accordance with the Subdivision Map Act of the State of California and HBOC Chapter 99 , CITY is required to reimburse BUILDER for the cost of the supplemental portion of FACILITIES, NOW, THEREFORE, in consideration of the convenants and agreemerits herein contained, the parties hereto agree as follows : 1. CONSTRUCTION BUILDER has constructed FACILITIES at a total cost of Nine Thousand One Hundred Thirty-six and no/100 Dollars ($9 , 136 . 00) . + 2 . DEDICATION BUILDER has dedicated FACILITIES to CITY. 3 . REIMBURSEMENT The total reimbursement to be paid BUILDER for the supplemental portion of FACILITIES is the sum of Two Thousand Three Hundred Fifty-four and no/100 Dollars ($2,354 . 00) , plus legal interest accrued hereunder to the date of said reimbursement . Said reimbursement shall be made by CITY to BUILDER upon certification of CITY' s Director of Public Works to its Finance Director that BUILDER is entitled to reimbursement by reason of connection having been made to FACILITIES in accordance with the Huntington Beach Municipal Code and this Agreement . REST OF PAGE NOT USED -2- 4 . ENTIRETY This writing contains the entire Agreement between the parties hereto. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers the day, month and year first above written. BUILDER: SEA VIEW`, HOMES, DELAWARE CITY OF HUNTINGTON BEACH, a Califoorlya unlimited partnership a municipal_ corpe-ration of the State of California /ex /f an sssounian Mayor General Partner ATTEST: APPROVED AS TO FORM: City Clerk l 4' City Attorney y� s =qo REVIEWED AND APPROVED: NITIATED A D APPROVED: City Administrator Direc or of Public Works ko -za -q n -3- ��-7111l11111111111111l11 �� '� um uuuum 11111111111111111111111 � � � ��,� �� ' �'� _ 1111111 = ,: N as aaII1H Nlli�N �! ��'�� i�� ►►� 1111111 = NNE allllllil BRUIN Illllil IIIIIII = III IIIlmN lease NRINI ■= =_ ■ IiliNl-'� Iltlllll aN�IU CNN;, NNNaa �lNll �NIaN N�IIa - io1 •'►�hiuu n n 6_ sell Allllla Ilaal lalil INS INN p p IaNlll- IINNh II WIN IIII MINI MINI NON oNlaa INIIN INIIII aNIINN m� ■ 1111111 alaNaHUHN all Hong- MIN .. _�■ aal�� ummui MINI mafaN IIIIN ImIllmu IIINIIN III01H JINN INNla 1111� �elth 0 aaa aNlNll HInga NIaaN.pull,I�IIlI 11111E ■s Illa� aaaaa s N�aa �— �� --+ �:a•r+,�" � �. aIN�INa m M mi m a m mil w$ milk m USHE mall ,__Z — E�I�a -�� INIIEI_ aallal_ IIENallllllllllll" Ilh '�_ EIIIN�NI.NaII1IIINaI�' ■NII aROD ■i ,��\��'� �\�. �Illl�llNb 1116 . a III�t�,�.��,� �i��,q�.! �%i��/ I HIM MR 404 4 ` TEIR fnivIS10N V11 AV i_ 1990 Distribution: CITY OF white: Requesting Department HUNTINGTON BEACH Yellow: Office Control File Pink : Assigned Staff Member REQUEST FOR LEGAL SERVICES FOLLOW-UP MEMORANDUM To: Don Noble/Ron Upton From: Office of the City Attorney Subject: Your Request for Legal Services Date: 5/15/90 This will acknowledge receipt of your Request for Legal Services, below listed. Dated: 5/14/90 Type of Legal Service Requested: [ ] Ordinance [ ] Insurance [ ] Resolution [ ] Bonds [ xx ] Contract/Agreement [ ] Opinion [ ] Other: Description: Reimbursement ag 90-W1 - Bi jan Sassounian This Request for Legal Services has been assigned to PAUL D ' ALESSANDRO for handling. He/she can be reached through extension 5555. 90-349 The Control Number assigned to this request is: Please reference this number when making any inquiries in regard to this matter. Thank you. 0673L Bran Ussoun i n RECEIVED WATER DIVISION MAR 21990 February 26, 1990 CITY OF HUNTINGTON BEACH. City of Huntington Beach Department of Public Works 2000 Main -Street Huntington Beach, California 92648 To Whom It May Concern: We hereby request the preparation for the reimbursement of the oversized offsite water system located at Memphis and Delaware in the City of Huntington Beach. Included please find the bid proposals for said work as requested. Our houses are located at 1217 and 1219 Delaware Street, Huntington Beach. Reimbursement should be made to Sea View Homes - Delaware, owners of the property. Sincerely, SEA HOMES DE ARE B" sso i General Partner 2124 Main Street,Suite 110 • Huntington Beach,California 92648 • (714)960-5505 • FAX(714)960-8284 i Sea View Enterprises RECEIVED WATER DIVISION November 27, 1989 DEC 1 1989 CITY OF Mr. Jeff Renna HUNTINGTON BEACH' City of Huntington Beach P. O. Box 190 Huntington Beach, California 92648 Re: 1217 and 1219 Delaware, Huntington Beach Dear Mr. Renna: We are happy to inform you that installation of a 12" water main, as per your request, has been completed by Kana Pipeline. I have attached documentation for your review which includes the bid proposal for the installation of an 8" water main in the amount of $6,782 , as well as a copy of the contract for the 12" which was completed in the amount of $9, 136. Per our agreement, please issue a check payable to Sea View Homes Delaware in the amount of $2 , 354 which reflects the difference between the installation of the 8" and 12" water main. We would like to take this opportunity to thank you for your continuing cooperation. Sincerely, SE_ W HOMES DELAWARE S s / General artner 714-960-5505 • FAX 714-960-8284 2124 MAIN STREET, SUITE 110 • HUNTINGTON BEACH, CA 92648 J 1i17.'89 0 5 a 714 220 2036 AA PIPELINE ..�— / r,.w 02 KANA PIPELINE P.O. Box 2017 MUM Orono•, CA 02860-9817 714.1761-4838 �-� FAX:7141220.2036 CONMACrORS LICHNSL +resrles BID PROPOSAL AND CONTRACT TO., Smi View Homes DATE. November 6, 1989 2124 Main Street, Sc>_lte 14.0 11wiLington );leach, CA 92648 JOB LOCATION: 1217 & 1219 Delaware Muit•.ington Beach, CA Attention: B1.11 Beck TRACT OR JUB NO.., CONST. NOTE UESCHIPTION PRICE 8" WATER W14 1 . ) Remove Fire Hydrant Previously Relocated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 300.00 2. ) Install Abandoned Fire Hydrant. 01:f New --- 's" Main . . . . . . . . . . . . . . . . . . . . . 1 650 OU 3. ) Construct 8" PVC CL 150 C-900 Water Main. 67 LF @ $46.00 PLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,062.00 4. ) Construct One 4" Blow Oft' Assembly Leas 4" Gaco Valve. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525.00 5. ) C0118LrucL Une 8" Gace Valve To Grade. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 875.00 h. ) Ourmccl Tu Existing 8" Flange. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350.00 '-roTAL 8,MAIN. . . . . . . . . . . . .. . . . . . . . . . . . . . 6 782.00 NOTES SAME AS ORTGINAL COMfRACT, ITOTA-L CONTRACT' R10E 1' $6,782.00 _. _ _ ACCEPTED BY., KANA PI EL NE ITS' �..._... _� BY. / c -MPANY DanielAlan Locke 1l%17.83 5 3 714 220 2036 11A PIPELINE '`w 03 c Manor KANA PIPELINE P.O. Box 2817 Slow Qranso, CA 02669.2817 Ifillow, �' dllWWlnK~ 774%761-4838 Manor FAX 7141'220-?.036 doww' 00NrnAUI(111:LICENSE I46101 BID PROPOaAL AND CONTRACT 70. :lea View Bonle.s DATI_'.' November 6, 1989 24214 Main Street , .S'ui t.e 1.10 I1ulttine,ton lieac h, CA 92648 JOB LOCATION- 121.7 &1219 Delaware At:Lmnlic;n: Aill BeckIluitLingt.ut1 Beach, CA 92648 TRACT OR JOB NO.: CONST. NOTF. DESCRIPTION PRICE 12" WATER 1IA1N 1 . ) Remove Fire hydrant Pre.vi ou.9.1 y ReJ ocated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .a :i00.00 L : l Install. Ahandonp.d FtrP Hydrant Oft Jv'�ew 12" Muin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ,80(),UU i, ) (.;uI15t.z'ut:t 12" PVC CL 150 C-900 hater Main. 67 LIB to $66.00 PLF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,422.00 '...i Construc:t. One 4" Now Off Assembly Less 4" Gitt.0 VA.1ve. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600.00 j l;c>rlStruCt. Uuc 12" GaLu Valve To Grady. . . . . . . . . G, 1 (,uusec't. Tu 12" Flange Lett by City. . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . 1 494.00 TOTAL 12" WATER MAIN. . . . . . . . . . . . . . . . . . . . .t9j 136.0U NOTES SAME AS ORIGINAL CONTRACT. TOTAL CONTRACT PRICES'. . . . . . . . . . . . . . . . . . . . .�9,136.00 r •' ACCEPTED BY: KANA PIPELIIV� , ITS BY. COMPANY ---------•- f1, ,_ �_�llllllllllllllllllllll �� ttttt tttutttttt 11111111111111111111111 � � �' �� t _IIII ilk 111�1 11111 IIII: �.�� '�' _• �� IIIIIII = umnall go gnu MIN 0 1WIN = �111 III�A I AA A1111 �= == 1111111. 1111m AAmIII MIR 11111 �IAII 1III1A MIA `.��ttiittU �!�"• '"""" ��' AAAfi A11111A 111A1 11111„ n11 a1AA1 IIA�A plAllll plllAn :: � 11111 111111 111111 A11t� 1�1 d11AA 11111 AAl1I1 AAllll .� � ■ :: � 1 111111 1111A AAA �� 1111 IIIII� l�All 1111� �� a -� � :: �� 111�� 1��1 A1111 �I�A A1111 l�l� 1111111 lll�l �lll IAlll llll� • quu. 11111 NIIAI lllll.1 11.1 11111 1111� 111A1 loll illy° � � _� ��•�� .��. � ��, � �' � �® _- _ �� 1111A1 �� _ ��•�� 1l1� �� IIII ��- � ��"m 111 A111111111111 A111111A11111 IImIAlllllllllll" N Buell IN _ illllllilillifi•iffilffli if IiD ilililflflflfifUffiill �1 _� 111 INII„ �� ®IIIIIIIIII Illllm '�11 111A�� • .�� ,��, 111 111A11 �� _�� _� ,��'@�►�� :�1111�111 �Alll '�N:1A111 � �q�,��,!��i,� AAA ®N�� _� �a �►��NIIIIIN�►� _ i�� '' ��j'�•,�'�i,Q;�/� d li/17%6.3 f1� a 714 220 2036 A PIPELINE " "w 03 momr KANA PIPELINE P.O. Box 2817 � Orange, CA 02689.2817 (11111w' �' !14!7Gr-QB3A FAX 71 A/220-2036 146!481 QED PRO PO AND CONTRACT 1-0 5en View Homes DATE:' November 6, 1989 2124 Main Street., Suite . 1.10 111.111titigtoll Head), CA 92648 JOB LOCATION.- 121.7 1,4219 Delaware AIA-m -ion: Bi.I.] 11sc:k 11utlLitlt;t.ut1 Hea<:11, (,A 92648 TRACT OR JOB NO.: CONST. NOTF DESCRIPTION PRICE 12" WA`LT'R MAIN 1 . ) Remove F i re Hydrant Previously he.1 orat ed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 00.00 L_ 1 1i stall. Ahandom-.d l?1.re Hydrant Off NetY 12" Mair1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,$0U.UU i. ) (.;(-)Il5trucL 12" ITC CL• 150 C-900 Water. Hain. 67 LF C2 $66.00 PLF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,422.00 �+_ i C:c ustnlc:t One 4" blow Off Assembly Jess =!" (.m.(! Valve. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -100.00 ',. i l:c,n5truc'l. UucI 12" Gate Valve To Grade. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. ,520.00 6. (.;otuiect. To 12" Fl.anye Lett by UitS.. . . . . . . . . . . . . . . . . . . 494.00 10TAL 1.2" WATER MAIN. . . . . . . . . . . . . . . . . . . . ..L9.,136.00 NOTES ;SAME; AS ORIGINAL CONTRACT. TOTAL CONTRACT PRIC13. . . . . . . . . . . . . . . . . . . . .�9,136.00 ACCEPTED BY: KANA PIPELII� / I T S By: COMPANY ,,- 11/17.189 0. i a 714 220 2036 iA PIPELINE v - a. 02 KANA PIPELINE P.O. BOX 2817 _ _ Orange, CA 02689.2517 714.1761-4638 _ dMMk^ FAX.-714I220.2036 CO TRACrORS LICENSE BID PROPC.CAL AND CONTRACT TO: Sc;a View j1omea DATE; November 6, 1989 2124 Main Street, Smite 11.0 1lurltington Beach, CA 92648 JOB LOCATION, 1217 & 1219 Delaware ttuntington Beach, CA Attention: B1.11 Beek TRACT OR JOfi NO.. CONS7. NOTE DESCRIPTION PRICE 8" WATI R WN 1. ) Remove Dire Hydrant Previously Relocated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 300.00 2. ) liista.11 Abandoned Fire Hydratlt; off New --- " rfslll. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,65O.ou 3. ) Construct 8" PVC CL 150 C-900 Water Main. I 67 LF @ $46.00 PLY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,082.00 4. ) Construct One 4" Blow Off Assembly less 4" Gaco Val.ve. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : 525.00 5. ) construct one 8" Gate Valve To Grade. . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . 875.00 Correct To Existing 8" Flange. . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . 350.00 TOTAL 8�MA.LN.. .. . . . .. . . . . . . . . . . . . . . . . . . NOTES SAME AS ORTGINAL CON'RACT, - TOTAL CONTRACT PRICE $6,782.00 ACCEPTED BY., KAN,4 P PEL NB ��MPANY Daniel. Alan Locke Bean USSOun i an RECEIVED WATER. DIVISION MAR 21990 CITY OF February 26, 1990 HUNTINGTON BEACH City of Huntington Beach Department of Public Works 2000 Main Street Huntington Beach, California 92648 To Whom It May Concern: We hereby request the preparation for the reimbursement of the oversized offsite water system located at Memphis and Delaware in the City of Huntington Beach. Included please find the bid proposals for said work as requested. Our houses are located at 1217 and 1219 Delaware Street, Huntington Beach. Reimbursement should be made to Sea View Homes - Delaware, owners of the property. Sincerely, SEA HOMES DE ARE B" ssou i General Partner 2124 Main Street, Suite 110 • Huntington Beach, California 92648 •(714)960.5505 • FAX(714)960-8284 Sea View Enterprises RECEIVED WATFR DIVISION November 27, 1989 DEC 1 1989 CITY OF Mr. Jeff Renna HUNTINGTON BEACH City of Huntington Beach P. O. Box 190 Huntington Beach, California 92648 Re: 1217 and 1219 Delaware, Huntington Beach Dear Mr. Renna: We are happy to inform you that installation of a 12" water main, as per your request, has been completed by Kana Pipeline. I have attached documentation for your review which includes the bid proposal for the installation of an 8" water main in the amount of $6,782, as well as a copy of the contract for the 12" which was completed in the amount of $9, 136. Per our agreement, please issue a check payable to Sea View Homes Delaware in the amount of $2 , 354 which reflects the difference between the installation of the 8" and 12" water main. We would like to take this opportunity to thank you for your continuing cooperation. Sincerely, SE. W HOMES DELAWARE S s General artner 714-960-5505 9 FAX 714-960-8284 2124 MAIN STREET, SUITE 110 • HUNTINGTON BEACH, CA 92648 REQUE51 EQE LEGAL SERVICES - QONTRA •T PREPARATION 1 . Name of Contracting Party �►Jact� Sks soot�1#4 2. Capacity of Contracting Party : (Check one) . 1 ) ( ) Sole proprietor 2) ( ) Corporation 3) ( ) Unlimited partnership 4) ( Limite partnership 5) Other ,& kk,v (Stat ) 3. The purpose of this agreement isrM�,�a�-S�h'I�t�'r CC-)STS ►�CW 0t 1 OVEESiZEU v&/ATEF MAIL N 11-(Srp-t._LAT►c*A 4. Who will sign the agreement —BITAJ4 Sa.556Ui� 'What is his/their title e tjERAL -en Oeg What is their authority to sign* (� Owner General Partner ( ) Corporate officer 5. What is the duration of the agreement ears/months(circle No. one) 6. What is the consideration for the agreement (who pays whom and how much?) 7. When and how are the payments to be made (all in advance, all in arrears, progress payments, etc .?) 8. Who will approve the agreement for the city initiating department? L-001S op -p-Liet-)c WbelCS Name , Title * SEE 2. ABOVE - If 1 ) is filled in then owner signs ; if 2) then President/vice president Aj3j .Secretary or Treasurer = co_py of authorizing action of board of directors; if 3) or 4) one or more of the aeneral partners. 9. Have the procurement ordinances and charter provisions been complied with? Yes/No (circle one) VA 10. What special risk to the city is involved in these agreements? 00t 5 ( ) Food & Beverages served , ( ) Construction work, ( ) Motor vehicles used, ( ) Maintenance work 11 . What is the latest this assignment can be completed 'bey! the City Attorney to meet your deadline? vv (bate) 12. Does the other party desire the city to provide indemnifi- cation? Yes (circle one) Why? 13. Has the other party been advised as to the city 's require- ments in regard to worker 's compensation, insurance and the indemnity (hold harmless) agreement? Yes/No (circle one) Have y_ U handed the other party a copy of the current reso- lution and certificate of insurance blank to be filled in? Yes/No (circle one) 14. Who is our contact at the other party to resolve the con- tractual problems? Name B ITA k( SA51>00141 AO Telephone t-7 14) 960 - 55 05 Title 15. Have you attached a copy o the "work statement?" Yes/No If not, why not? 16. Are any State or Federal funds involved? ( ) State ymaw- GI ( ) Federal All requests must be approved by a department head t=-- City Administrator . oved)