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<br /> 2 . - y
<br /> AGF.rL Ccr.ri".LIST
<br /> ware and attach this c• iecklist •to all requests going: to the County BoatF rd •for.approval
<br /> INITIALS 'D PT ..
<br /> t
<br /> 1: Attach justification .for .request. Summarize the reason for the
<br /> agreement::and attach ;the agreement Include 1„
<br /> ...,.-.:',::.:.:...;.,....::-..::'..:,.,.i.-.-,:.:•-..-::..,--.;.....;..;,..:-.,..:.--...,..;.,::,..;..-..:„.:,,:,::.:.i.;::•,....:i-.,','.;:..,.-,F..,.:.!..,,-...•.I.';:.-,.',t:4•-.1.A,-';.;•:.:.,-'--:,.;....*.-:.7„.,,;,•::,.f.'•,-:.•..,;:."i4ls-.l.,'„a.7\.-.....,..:'.'.,..-21,.:';..-.:•.;•;,:•:,,-',.:.A::„':.-:.-:‘7•e,.),..'--4,,-;-,,1•,':,::•:,''.--;.:.•li,i-:;::.sc;,.-•s-.4-,:::-:-.-1."...:-
<br /> a Scope of service
<br /> r t
<br /> b Cost:.
<br /> .Is .where:a. cap on.;',-t.he cost?_ Yes %� ' No
<br /> c• Indemnificatio• n •clauseF ,: w ?^C
<br /> d Insurance • ,} _
<br /> e Termination , _
<br /> 2 -.Fundingi ? 4',,.5:>:j -_ :, ,:.” {,. 3 -,..;-,•;.....:;42:-...i.-•,,,••••;, .*.>t
<br /> a Included in approved +budget for funding ,year? Yes . No• x A ' ;, q~
<br /> t w.:
<br /> ..••••..,..::-„,.......,_,....,.....,,,,,.....-„,:.,._..„.„.Ifunds rare, to be 'obtained from other;source '-' ., +{k�"
<br /> .
<br /> .;Attach .budget..adjustment„for :revenue and/or appropriations ,`': ,
<br /> Attach explanation for;appr •oprlate ,transfer N�, r
<br /> .',-i',9,t2;i_:''..:.',..:.'..'_.;';7....:.'.'::_
<br /> +•
<br /> m r rs
<br /> 3. Required signatures ▪ '.� ' '° f
<br /> r ' a• •Department Director Signature/appr• oval --2.-.;: .V:;?:::.-..1: , 5
<br /> b ,` , b i Risk`Managemen Insurance requirements • Y s
<br /> j
<br /> c }::County Attorney Form„ and legalitq ;. � • 4
<br /> d :' Budget and Accounting Availability of funds • r � ,
<br /> 5
<br /> Drast of County Board Resolution,: », y
<br /> ”` ': Include the- reasons:•for..the action:.; i�REAS ,• _
<br /> Include •in. draft the.°exact ,;action you are requesting £,
<br /> • of the:County Board:`.: .RESOLVED.
<br /> r
<br /> •
<br /> 5. Grammar, spelling and math' is double-checked on each document
<br /> 6: ;Draft resolution approved by Chief Clerk '��1
<br /> .• .. •;.-,2.t.-:-- }
<br /> •
<br /> Comments r { .TM z::
<br /> 4
<br /> f
<br /> . .i .r. �JJ.,' `� b33-03) •Z92=7 � 8 -9a
<br /> Pre rer's'�5ignature ;Telephone,_
<br /> Date.
<br /> CERTIFICATION STATEMENT
<br /> Documentation certified complete•
<br /> r:
<br /> I Environmental Svs. 8/21/90 (i _
<br /> 8/10/90
<br /> Committee/Meeting Date - • Signatu e - Date. .
<br /> neYVZ.Gt - . *
<br /> !SmmetinDate '• ...&it46 e D to
<br /> I County Boa d Date . Signature Date
<br /> • C-1
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