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f <br /> LEE COUNTY <br /> , <br /> CONTRACT COVERSHEET <br /> (This information box is to be completed by Department when submitting a contract for review) <br /> Date Submitted: 5 J / a ü <br /> Department: OSS j �p�Contact Person: elk ' <br /> Telephone: � E-mail Address: U fl ue) g ( i/Vn C _ e ✓ , <br /> Vendor Name: OEMe.,.• <br /> Type of Contract: New ✓enewal Amendment 7Services Goods <br /> ___Consulting Construction _Lease _Other: <br /> Description/Scope of Work: CA P 3 U 1`OP Q-rt,e,( cis;15)W Le_, L 11 L � C,bLs� <br /> C Our) le S, s 9y <br /> Funding Source: , ounty _State Grant ✓Federal Grant Local Grant <br /> _To Be Financed Other: <br /> ' Total Contract Amount: • L the / Af kilitc Contract Period: FY dV - <br /> 1 t6 I a i ; <br /> Fiscal Year Amount to Encumber �tequired Forms Checklist <br /> FY Iran Divestment/E-verify <br /> .e <br /> FY Pre-Audit Certification/Signature <br /> FY W-9 Tax Form for New Vendor <br /> 4- <br /> FYnLocal Signatures Required: County AttorneyCounty Manager <br /> 1/Department Head <br /> ✓Board of Commissioners (Chair) _Other: <br /> Review Progress <br /> I (Please initial and date once reviewed.) <br /> 1'v Department Head <br /> ) B,Comments: L5)1 11CtiLQ G1 tXGl Lir' ref)�Ur � � it1,l . 0 LCLoIT (Applicablenly forhardware/softwareservices) <br /> purchased or related technology services <br /> Hardware/software contracts must be reviewed by IT before submitted to the County Attorney. ) <br /> ,t ZU County Attorney <br /> Comments: <br /> Finance <br /> County Manager <br /> Final Steps, <br /> (Once the contract has been reviewed/signed by all parties) <br /> Return FULLY EXECUTED (signed by the vendor)copy of contract to: <br /> Marilyn McKinney(if the contract was signed by County Manager) <br /> Jennifer Gamble(if the contract was signed by the Board of Commissioners) <br /> :.-$ a %,- nT. ,,. -7'1. --4:4'A_._-.gig . :., s« <br />