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• Tj CONTRACT COVER SHEET Mera-00-45-S <br /> GAO LOG <br /> CONTRACTOR Erne r Id Va 1 ley MIX GAO LOG DATE <br /> AMOUNT $ / .00 annuall <br /> ( 1 DEPT/DIV. County Administ rat ion <br /> BUSINESS I.D. NO. CONTRACT <br /> TITLE OR CONTRACTUAL MODIFICATIONS/AMENDMENTS <br /> f!as.217! Afeernnt - To provide act 1 v 111 P ice <br /> y-:uth uf thf.. cor for spf.:ri of Original Amount <br /> June , 1992 <br /> CONTRACT TERM: jun•-_-, Increase (Decrease) <br /> " Total Prior Change <br /> Dept. Head Approval (Signature) <br /> Total Amended Amount $ <br /> - - <br /> 0 Time Extension - <br /> Dept. Contact Person and Extension <br /> 0 Other --- <br /> SELECTION <br /> INFORMATION: D Quotes/Bids Not Required — Reason Lt..5( Agreement <br /> D Quotes: Names of Quoters $ Amount Date Written/Informz <br /> 0 Public Bidding — Attach Recap Sheet and Bid Cover Sheet. <br /> BUDGET: CURRENT FY c SUBSEQUENT FY <br /> Accounts Affected N/ A i, $ $ <br /> Ell Previous Board Action: Date.: 92- 5- 1 0 Grant: <br /> 0 Revenue Contract <br /> 0 Non-Financial Agr9einent <br /> Insurance Certificate Attached? :I Yes 0 N�3 0-'N/A Performance Bond Attached? IN Yes 0 No 0 N/ <br /> FOR DATE FORWARDED SIGNATURE DATE RETURNED <br /> GAO APPROVALS: <br /> USE ( Legal Counsel ' Date - --Budget & Research Date <br /> , <br /> ONLY ) Risk Mgt. Date Co. Admin. Date <br /> To be completed by Finance. ATTENTION DEPARTMENTS: This contract is encumbered under the PYMT CONTROL* and ACCOUNT #'s an <br /> the $ AMOUNTS shown below. All payments must be processed under this PYMT CONTROL *. <br /> VENDOR CODE CURRENT FY SUBSEQUENT FY <br /> PYMT CONTROL * CD_ ACCOUNT NUMBER $ AMOUNT $ BALANCE <br /> CONTROL DATE TYPE <br /> )ESCRIPTION <br /> • REF/CONTRACT # <br /> REF. DATE <br /> REV. 1/89 <br />