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.', - tTANDARD CONTRACT COVER SHEET <br /> G AO LOG <br /> :: �:- In <br /> CONTRACTOR Erne ra Id V a I I e v 131 GAO LOG DATE <br /> AMOUNT$ 1.00 annually <br /> t i DEPT./DIV. County Administration <br /> BUSINESS I.D. NO. CONTRACT # <br /> TITLE OR CONTRACTUAL MATTER��_ MODIFICATIONS /AMENDMENTS <br /> L ««os- ?zreerna -nt - To provide act 1 vi TSI' :-�-----, ..........__0 Price <br /> v -;utr, c:f .- community for Sh_r . Original Amount $ <br /> CONTRACT TERM: - n n 4 • 1 992 TO Jun 3, ` Increase (Decrease) $ <br /> - • Total Prior Change $ <br /> Dept. Head Approval (Signature) <br /> Total Amended Amount $ <br /> ❑ Time Extension _ . - <br /> Dept. Contact Person and Extension -. - ° <br /> ❑ Other --- <br /> SELECTION <br /> INFORMATION: EJ Quotes/Bids Not Required — Reason t t. s e Agreement <br /> ❑ Quotes: Names of Quoters $ Amount Date Written/Informa <br /> ❑ Public Bidding — Attach Recap Sheet and Bid Cover Sheet. <br /> BUDGET: CURRENT FY , i SUBSEQUENT FY <br /> Accounts Affected: T / A $ $ <br /> $ <br /> .,- $ <br /> IS Previous Board Action: Date..- 92 - 5 - 1 T' •- 2 ❑ Grant: # <br /> e Revenue Contract <br /> ❑ Non - Financial Agrgement <br /> Insurance Certificate Attached? ® Yes ❑ ;.❑''N /A Performance Bond Attached? ® Yes ❑ No ❑ N// <br /> FOR DATE FORWARDED SIGNATURE DATE RETURNED <br /> APPROVALS: <br /> GAO <br /> USE Legal Counsel - Date _ --. Budget & Research Date <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 /> ACCOUNT NUMBER $ AMOUNT $ BALANCE <br /> PYMT CONTROL # CD. <br /> CONTROL DATE TYPE <br /> DESCRIPTION <br /> REF /CONTRACT or <br /> REF. DATE <br /> REV. 1/89 <br />