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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 I I baa <br /> Department DSS Contact Person: an1A.,rte._ NUR--)1 <br /> Telephone: x j a E-mailc"i Address: cLr c 10 <br /> Vendor Name: <br /> Type of Contract: New /Renewal Amendment 1Aervices Goods <br /> Consulting Construction Lease Other: <br /> Descn tion/Scope of Work: <br /> � uOLtOb n5� ►'UI e <br /> Q L <br /> Funding Source: _County /State Grant ✓ Federal Grant Local Grant <br /> To Be Financed Other: <br /> Total Contract Amount: Contract Period: <br /> Fiscal Year Amount to Encumber Required Forms Checklist <br /> FY as-�3 UO / Iran Divestment/E-verify j Z �/ Pre-Audit Certification/Signature <br /> FY r11 f W-g Tax Form for New Vendor <br /> FY <br /> FY <br /> Local Signatures Required: County Attorney County Manager Department Head <br /> Board of Commissioners (Chair) /Other: SA ill( r <br /> Review Progress <br /> n ! (Please initial and date once reviewed.) <br /> -/�!il Department Head o ^' ' I <br /> Comments: OD /c nOL -41/ o CC1�'1 <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 /> 4h))0. 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 /> Susan Mills (if the contract was signed by County Manager) <br /> Jennifer Gamble (if the contract was signed by the Board of Commissioners) <br />