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CONTRACT REVIEW SHF.ET <br />Person Sending: <br />~``~ Date Sent: <br />The attached: ccz <br />Contract <br />:~ <br />;\< z <br />INCOMING FUNDS? YES( <br />If incoming funds you <br />~`~ l~ ('~SC r <br />~ \ ~ ~<~q`1 <br />Department Name: 1... ~. ~~,\ (;o;,,~;, ~\ <br /># <br />Grant Lease <br />) (CIRCLE ONE) <br />attach a Revenue Management Sheet <br />Contractors (~ '~ <br />~~(^•~1V1 ~1!`~ U.~ SG~~~/"^ 1~~~.C~ ~~aCt`i`~ ~r=+~S.} _1.1~f~G~ <br />Name: <br />Date From: Date To: ' <br />Amount of Contract or Amendment: ' <br />If an Amendment, New Contract Tota1= $n/a <br />Certificates of Liability Workers Comp If no insurance attached,why not? <br />Insurance (circie one) (circte one) Q~2~~~~ „ - (~ / <br />w`x~,.~ <br />Attached: <br />Yes No <br />Yes o . U <br /> <br />Description of Contract Services: <br />f'~T~..~~~s ~,{.:~4;,,c~ `~.~~e~yov~~~R~~k0.~ 7~.,~-z~~~N..~..~ (~~see~rH2~~' '~~ <br />J <br />t~.~\ec,~' Shbc'.~~ oF (11c~~~c~C e-~DZ+~StS 'Foc- C,c>~5~~-'-t~~>or. ~~' ~ar~~,o.ASC <br />\ <br />5„b~-ar~. ~co.Se~ c,.~ ~,~z~.~~- c..~.~~~;.~k<< ~:~ ~~-z~a ~~~ acc~~~t~ ~'~ <br />S:ar~: v~ ;~-. a ./~ ~~ ~~+~~ 5e s s'. ~h~ A r. a (~- ~~.~.. t= ~ R ~ a„~ :~c'~C~. ~ ~~-L`.•.1c,'.'~s <br />t~L <br />0 <br />J <br />1. \ <br />~~~~ nw.o~.~ ~F t~a.., `S-~~'C ~G0.~:~'..4 ~'~- ~fi.tr.i.t' ~.<~r\G'IS c~~,t~t,~~'c~~ \~ M6'.nTU'.r <br />J <br />J <br />J <br />~'^ <br />/'`~~ i~„(~~J \~` <br />~ <br />W ~ ~ ~ A l1~ i d`'(~ LiN ~\ `. ~. 0 'J 1' C~ -C Y~. ~ ~ J-~! 1 ~ '~ (~lL, ~ \ ~ ~ •~ ~/ ~ <br />J <br />For Risk Management Use <br />Date Risk Received: Date Scheduled on BOC Agenda: <br />Authorization for Health Adminisuation to Additional Comments: <br />sign on behalf of BOC: <br /> <br />yes no <br />Staff Review Signatures: <br />Risk Management date Fiscal Services date <br />~ ~~ s ~ ~~ ~ <br />General Services date Le al Cou e date <br />~ Date: - <br />~eturned to Department/ for signatures. <br />Copy to f'ucnlServices / <br />Reveiw.CON 1/97 <br />