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... .. + . .. - _ - . ~ ' ./ . f <br />~ <br />~ ~~\ ~~~ ~ }~ ~ ,l ' ~ <br />~ CONTRACT REVIEW SHEET ~ <br />Person Sending: Department Name: ~T ~ ~J` <br />Date Sent: 3 6D <br />The attached: (CIRCLE ONS) <br />Contract Amendment #21 Grant Lease Intergov't Agreement <br />INCOMING FUNDS~ YES NO (CIRCLE ONE) <br />Contractors ~Q~~ ~`~L~ <br />Name: <br />Date From: Date To: <br />Amount of Contrad or Amendment: ~ J~~„ U l7 <br />If an Amendment, New Contract Total =~ 2E~ 2 3 Z--$ S <br />Workers Com If no insu~ance attached, why noti <br />Certificates of Liability (circleone) p <br />Insurance (circle one) <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 Services: <br />,~. ~ C~ ~ ,Q~, ~-~ ~. . <br />~ <br />Date Contrad Received: Date Scheduled on BOC /~genda: <br />Authorization for Health Administration to Additional Comments: <br />sign on behalf of BOC: <br />yes no <br />Staff Review Signatures: <br />date Legal Counsel date <br />Contracts Coordinator <br />Risk Manager <br />date <br />~'~ '"'~ ~„ ,,,,,,6,,.,. <br />~.t~.1 ~ ~r..~.,/ <br />Review.CON 8/99 <br />