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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/(951;0 <br /> Department DS5 Contact Person: Cn rtc,—h <br /> Telephone: S' E-mail Address: a_ O,t EJ I t� <br /> Vendor Name: <br /> Type of Contract: New Renewal Amendment Services Goods <br /> Consulting Construction Lease Other: D+S <br /> Description/Scope of Work: <br /> V)(-}14S moL <br /> Funding Source: County State Grant Federal rant _Local Grant <br /> To Be Financed Other: <br /> Total Contract Amount: Contract Period: <br /> Fiscal Year Amount to Encumber Required Forms Checklist <br /> FY 2017/2018 Iran Divestment/E-verify <br /> FY 2018/2019 Pre-Audit Certification/Signature <br /> FY 2019/2020 W-9 Tax Form for New Vendor <br /> FY 2020/2021 <br /> Local Signatures Required: County Attorney County Manager Department Head <br /> A3oard of Commissioners (Chair) Other: <br /> Review Progress <br /> 111\1 <br /> (Please initial and date once reviewed.) <br /> v Department Head , <br /> Comments: yr L45 MO <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 /> Susan Mills (if the contract was signed by County Manager) <br /> Jennifer Gamble (if the contract was signed by the Board of Commissioners) <br />