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~ <br />CONTRACT REVIEW SHEET <br />Person Sending: ~ Department Name: ~,G~~ ~~, - <br />Date Senf: /~`~ <br />The attached: cc~ E ONE) <br />Contract Amendment # ~ Grant Lease <br />INCOMING FUNDS? YES NO (CIRCLE ONE) <br />If incoming funds you must attach a Revenue Management Sheet <br />Contractors <br />Name: ~ /~ /~ /_ <br />~ 7~f'~ l.~ L~l'l ~7 ~'LLG~61,~ ,~~~ <br /> , <br />Date From: ~~ ~ Date To: ~~ ~~ <br />'Amount of Contract or Amendment: ~~~ <br />r ` <br />If an Amendment, New Contract Tota! _$n/a ~~ ( j ~~"~ <br />/~~~ <br />5' f <br />f <br />~ <br />Certificates of Liability Workers Comp If n~insurance attached why not? <br />Insurance <br />Attached: (~~ck one) (circle one) ' <br />~~~ ~/ <br /> Yes No Yes No <br />Description of Contract Services: <br />" GL~LD~.~ I~2~CGl~LI~~~..~~~'?'1/C~S:.~"" l~L%-~~~~'. ,~~~v~~1~ <br />~ ~ ~ / <br />~ <br />~ <br />~ <br />~ <br />~ ?~ /~~~ ~CC ~-l~~L <br />~ <br />~u ~Q- I~~CL ~ l~`~'~ ~.~~~~,~~' <br />~ ,~ z~~ ~~~~~ ~[~Z~~~~ ~~-z~ -~-~ <br />4~%~-~- <br />-~~~ `a~ J / ~ ~~7 • <br />For Risk Management Use ~ <br />Date Risk Received: Date Scheduled on BOC Agenda: ~ <br />Authorization for Health Administration to Additional Comments: <br />sign on behalf of BOC: <br /> <br />yes o <br />Staff R ew Signatures: <br />~ ~` /~~ . ~ <br />~'~~t.l <br />~iturnta bo veparunent/`~ AI.K-Gt. ~~r/~' <br />Copy dv ~'ucalScrvius / <br />, <br />~' ~~ ~ ~:~ <br />date Fiscal Services date <br />~.~ ~~.,_. ~ ~ ~... ~ e A.w~..z r ~ ~ 3 <br />/ <br />i <br />Reveiw.CON 1/97 <br />