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M1NM. <br />STAT. <br />SLcrION <br />Part IY. Contract for Lose than 15,010 <br />WDLKPAPt <br />YES NO LE/LLLNC:. r <br />471.SS A. If w interested effleer eaarad lets a <br />sued. 5 contract with the governing body was the <br />swunt involved net is excess Of S5,000' <br />1. Now MCh in Weiss or other consider- <br />ation did the interested officer <br />receive frog the governing body during <br />the course of the fiscal tear' <br />Name Amount <br />2. If there was a series of contracts <br />be.ween the governing body and the <br />interested officer with a total, <br />amount exceeding $5,000.00. was <br />each contract clesrly a separate <br />transaction and not part of we <br />overall transaction? <br />3. Did the governing body, prior to <br />periurmsnce of the contract or contracts, <br />a Jopt a resolution setting forth the facts <br />:as <br />dateraining that the contract price <br />was as low as or lower than the price that <br />the comodity or service cocld be obtAloed <br />elsewhere? — — <br />1. If Cws contract was entered into under <br />emergency conditions, did the governing <br />boJy adopt much a resolution wfter or <br />during performaoca of the same? _ — —__-- <br />5. Prior to payment of the contract, did the <br />Involved nfftcer file with the Clark of <br />the governing body an affidavit <br />stating: <br />s. the name of the Officer, and office <br />bald; <br />b. an lteslratlon of cosaodlty or <br />services firofshed; <br />C. the contract price; <br />d. the reasonable value; <br />e. the interest of the officer to <br />the contract; sad <br />2-1 <br />