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LEE COUNTY <br /> CONTRACT COVERSHEET i <br /> i <br /> (This information box is to be completed by Department when submitting a contract for review.) <br /> Date Submitted: 51L;1 a O <br /> Department: 5 S Contact Person: G-) : <br /> L <br /> Telephone: X St C 1 <br /> E-mail Address: 1 '► U s✓ aJ (ee_a_vu.ntinC J�--L/ <br /> . Vendor Name: ()Lt. �=neer'S4 Pr-c,q,r.�•S <br /> ,J <br /> Type of Contract: New (enewal —Amendment ✓Services Goods <br /> i <br /> __Consulting _Construction _Lease ___Other: <br /> Description/Scope of Work: C1 P 3 Li E 4,24-1.bryi ash i5 i&n CR 1- <br /> 61,4 r Lt, Lee eosin F-,1 I 4 I) J <br /> Funding ource: County State Grant ✓ Federal Grant __Local Grant <br /> _To Be Financed Other: <br /> Total Contract Amount: &.t( cii C a CC-II 1Gontract Period: FY ;it) - .2 I <br /> ' U. \ Ctlltl�a.1 ! .. <br /> Fiscal Year Amount to Encumber Required Forms Checklist <br /> FY ✓Iran Divestment/E-verify <br /> FY , Pre-Audit Certification/Signature <br /> 1101.1111. W-9 Tax Form for New Vendor <br /> FY <br /> LocalalSignatures Required: __County Attorney _County Manager �partment Head , <br /> ✓Board of Commissioners (Chair) _Other: <br /> Review Progress <br /> . yA,{�'v, Department Head (Please initial and date once reviewed.) <br /> AA) <br /> Crments: "11ill aka. dert4li (.2. -e 60(1 app kLJ 1OD% <br /> U(t4XtJ( (tL-J1.i1.tt.t ND (0L.L.,IL- int C-� <br /> IT (Applicable-only for hardware/software purchased or related technology services) <br /> 1 \n Hardware/software contracts must be reviewed by 17 before submitted to the County Attorney. <br /> /5\\\J VV\ County Attorney <br /> III Comments: <br /> Finance H <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 /> t:..'a.- - -i- - .:�..AS7i.' a"?9r.:.n.�.• ,-1., ...i.. �.';.ai'r'._....:i" - . <br />