Laserfiche WebLink
P 1~ C..~~~~1~ }`~~ M~ <br />~ CONTRACT REVIEW SHEET ~ <br />Person Sending: Department Name: C---~- ~ ~~ <br />Date Sent: Z \ b ~l ~I <br />The attached: ~CIRCLE ONE) <br />Contract Amendment # ~~1 Grant Lease Intergov't Agreement <br />Approved at Boo~d $e~~p~ <br />INCOMING FUNDS? YES ~(CIRCLE ONE) Dp~: ^_`_____ <br />Contractors ~ <br />Name: ~Q/~/LCSL ~ <br />Date From: Date To: <br />Amount of Contract or Amendment: ~~j~ ~~~~o <br />If an Amendment, New Contract Total = ~~ _~~Q <br />Certificates of Liability Workers Comp <br />(circle one) (circle one) <br />------------------ <br />Chairrr~an <br />If no insurance attached, why not~ <br />Insurance <br />Attached: 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 Service~ ~~ <br />~,~(~ ,:~.. _ ~..,~, 6v~ c~v~ li~--- Z~ ~ <br />~ ~ ~1~ , 1 ~ ~ ~ /~ <br />~~.~'~~ ~ G~'`~`~-- L .c.o_ <br />_ ~~ ~, ~-~; ,~. <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 />C <br />Ctaff P IPW SI UYeS: <br />_ ~ la ~ ~..~ ~~.~. ~~-~=~ « ~.~.~ ~~ <br />Contra rdinator dat Legal Counsel date <br />Risk Manager date <br />a.~~ <br />~7.wn..lFe ~5,0.,~.~d ~ "~^'G"'"- <br />Review.CON 6/99 <br />