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CONTRACT REVIEW SHEET <br />Person Sending: Department Name: ~ S,Q, ~ <br />Date Sent: ~j 20 ~p <br />The attached: (CIRCLE ONE) _.~, <br />Contract Amendment #~ Grant lease ~ntergov't Agreement <br />INCOMING FUNDS? YES NO (CIRCLE ONE) <br />Contractors ~~~ 1 ~ ~ n ~~ ~~ ~ ' <br />Name: ~ ~ ~ <br />Date From: ~ ~ Date To: ~ 2 ~ l ~ <br />Amount of Contract or Amendment: ~ '~ `~ ~ 2 yL. <br />if an Amendment, New Contract Total ~ <br />Certificates of Liability Workers Comp If no insurance attached, why not3 <br />I n su ran ce (circle one) (circle one) <br />Attached: <br />Yes No Yes No <br />Process taken to select contractor: <br />Verbal quote: Written quote: RFP: Competitive Bid: Renewal: <br />(Attach copy for reference) <br />Description of Contract Services: <br />~.Q,~c' ~...s~SL ~s~•--~ i ~ ~.~--. ~^~''~`. <br />- .~ ,~Q~ b ~.Q.~-~ a~ ~ G~--gr-~-~ ~- <br />~ `~ <br />Date Contrad Received: Date Scheduled on BOC Agenda: <br />Authorization for Health Administration to Additional Comments: <br />sign on behalf of BOC: <br />yes no <br />~~Staff Review Signatures: <br />Coordinator date Legal Counsel <br />~~Risk Manager date <br />date <br />~~: <br />~t'.a...d ~ ~5.~..~d ~. .y~. <br />Review.CON 8/99 <br />