Laserfiche WebLink
1 <br /> LEE COUNTY <br /> CONTRACT COVERSHEET <br /> (This information box is to be completed by Department when submitting a contract for review) <br /> Date Submitted: J J5 12 C <br /> Department: D S S <br /> p Contact Person: A riGE(;rir,_, <br /> : Telephone: '( S l E-mail Address: ail u e 1 I I eC C v;_.t_n r1 c •c c:J { <br /> Vendor Name: Q o m, i 011 r--r)el c,y I <br /> LL <br /> Type of Contract: New V /enewal Amendment /Services Goods <br /> __Consulting Construction __Lease ___Other: I <br /> Description/Scope of Work: C i P 3 Li E/1-P k),,,,.�,(, �C.J6)t5)&c C I <br /> � Y 3 <br /> Po( ' jc b( CGU/14 (e irl. n)S . <br /> Funding Source: __County __State Grant 1.7Federal Grant Local Grant <br /> -- i <br /> _To Be Financed Other: <br /> Total Contract Amount: at 1 �G C a• U Ca,ilSContract Period:til FY 2 0- 2 1 i <br /> LEMETIZI Amount to Encumber Required Forms Checklist <br /> FY t/Iran Divestment/E-verify <br /> FY , V Pre-Audit Certification/Signature <br /> FY W-9 Tax Form for New Vendor <br /> si <br /> FY <br /> Local ignatures Required: County Attorney _County Manager ✓ epartment Head <br /> _Board of Commissioners (Chair) Other: <br /> Review Progress <br /> i- V <br /> li J (Please initial and date once reviewed.) <br /> Department Head �J ki m(cud <br /> J tit <br /> comments; Q� na.a-u e S ( cu're. Kix' u-�,;(Jic2 l - I UU`/ Le u,o.I _ <br /> a y <br /> Ne �UC.n� r co-��_ <br /> IT(Applicable only for hardware/software purchased or related technology services) <br /> Hardware/software contracts must be reviewed by IT before submitted to the County Attorney. ! <br /> \\\\7&)V'1ounty Attorney <br /> Comments: <br /> Finance <br /> • <br /> • <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 /> ANTiiiimaiimvisi .�f 1..(.::....;FL7S+SL .:'TEi.7,:.. rr 97:,-, ...Ss".."T"-1AR.. YR:..tl a aki. _K ..°sr-"i <br />