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2. Governing Body Workshop Item Number
3. Council Item Number
5. Governing Body Workshop Date
   Governing Body Workshop Date
6. Council Date
   Council Date
10. ACTION ITEM SUMMARY
12. Submission Date*
    Submission Date
13. Submitted By*
15. Committee/Department*

    1. Administration
    2. Finance
    3. Public Works
    4. Safety
16. Action Item Type*

    1. Agreement
    2. Discussion
    3. Ordinance
    4. Presentation
    5. Resolution
    6. Other
18. Recommendation*
20. Details*
22. COMMUNITY IMPACT

    Utilizing a lens of intersectionality, illustrate below how this item would promote the city's commitment to equality, including improving social determinants of health:

24. Does this item benefit all racial groups?*
26. Does this item benefit Community for All Ages?*
28. Does this item exclude or disproportionately impact any social identities? If yes, what populations and why?*
30. What, if any, social determinants of health are impacted by this item?*
32. What, if any, are the unintended economic and environmental impacts of this item?*
34. How has the impacted community been involved?*
36. How will the program be communicated to all stakeholders?*
40. FINANCIAL IMPACT
42. Amount of Request
43. Budgeted Item?

    1. Yes
    2. No
45. Budgeted Amount
46. Paying Fund/Account
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

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50. Submit

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