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LEE COUNTY <br /> CONTRACT COVERSHEET <br /> (This information box is to be completed by Department when submitting a contract for review.) <br /> Date Submitted: 5 J I I a U <br /> Department: DSS Contact Person: allotLiAl�( <br /> Telephone:a '7 I g -41-114 C gCtiSj Address: (Zfue-I (Z/.e4)1Ank rte ;)V/ <br /> n � 5 <br /> Vendor Name: }� b ns I t Lk n Pea 1 fr <F.1 MU-If" <br /> Type of Contract: New /Renewal _Amendment y Services _Goods <br /> Consulting Construction _Lease _Other: <br /> Description/Scope of Work: ACIL4. I I- i C e <br /> Funding Source: l County VState Grant 'Federal Grant _Local Grant <br /> To Be Financed Other: <br /> Total Contract Amount: bta C91 '3 Contract Period: J/ "Jt 0 <br /> Fiscal Year Amount to Encumber Required Forms Checklist <br /> ✓Iran Divestment/E-verify <br /> FY re-Audit Certification/Signature <br /> FY Nil W-9 Tax Form for New Vendor <br /> FY <br /> Local Signatures Required: County Attorney _County Manager _Department Head <br /> Board of Commissioners (Chair) Other: <br /> Review Progress <br /> I'V <br /> J Department He9..c1 (Please initial and date once reviewed.) <br /> Comments: ) j &InLL{ NALL ( udS amyl to 1- <br /> &OC. <br /> appeova ) <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 /> 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 />