, , ,,•. .. . .~-` t '~ ~.-.:- ,~e. s.. . ;» ... t - <br />, ~ _ <br />t <br />~~ ~, ~ j t {~~ t . },. ~ .~ <br />~ . <br />. <br />. <br />.:. ~ . . :j i, '~. . .... -4_'~ .. : ' ;. . .. . . <br />4COVER ;SHEET <br />STANDARD CONTRACT' <br />/ <br />. <br />: <br />~I <br />~ <br />~ <br />GAOLOG# ~ <br />~ <br />r <br />" <br />-::. <br />~ ;: . . <br />~ ~=I ~ I <br />~ ' <br />CONTRACTOR ' ~ ~ ~ GAO LO.G DATE <br />° <br />z i - -, :AMOUNT. $ SU ', i~ o C.~ . <br />; . <br />n <br />_ `DEPT/DI,V l°~.iA C.5 A. ~l~'J <br />' <br />N'` I~ ' '. CONTRACT #` ~' <br />BUSINESS I D NO <br /> <br />, -~ . , . ~ ,; <br />, , <br />> , <br />TITLE .OR GONTRACTUAL MATl'ER ~':. S „ ; . ~' ` ' = MODIFICATIONS/AMENDMENTS <br />5~~~-t~/` a ~ v~/tn~,.~ern~`~ (~q re e r~~ e~.T ~ Pnce` ~' <br />- <br />, y ' <br />; ~ <br />, ,., r: `-, ; . .:' <br />` Original Amount , $ <br />~ <br />C.ONT GT ERM ~.a~-e n~ -~E K~c~1'~ ~," TO <br />1~~,~~ >'~ S f 99a '. Increase_(Decrease):,~ $ <br />, _ <br /> <br />; • . , . : <br />, . ' ,: . <br />,. ._, : ~', . Total <br />Prior Ghange : ~. ! , '$ <br />D pt He d A _ <br />pproval ( ature) <br />. ' ' <br />, <br />Total .Amended Amount $ <br />.. ~~ .'. . ~. '-. X 4 ~ - <br />.. <br />~ <br />: N~C~: G~~ 37~~ ~~, ~ ;~ ~ ~ ¢ ° <br />', ~ ~1~Y ~ .~ ,~ Time.,Extenston ~ . <br /> <br />- <br />Dept Contact Pe~son and: Extension :_ ~~ ~~' 4 ~ <br />' <br />. <br />~ Other" <br />~T ; <br />N <br />SELECTION ~ <br />~ e ca~, *~+~ <br />~'~~~~ ~~~~~~ P~r 1~ ~ I-1 c~ <br />INFORMATION <br />L11 Q <br />ofes/Bids Nqt`Re <br />uired Re <br />o <br />='~~ <br />, <br />; <br />q <br />u <br />as <br />n <br />, <br />, . <br />,. <br />, ~ <br />: ~ , <br />~ <br /> <br /> <br />~ <br />. ~, <br />, -~ , , , <br />r- <br />, . ~. <br />. ,,.. , >,. a . <br />: , a x $ . ' <br />` ^ Quotes': Names of (]uoters " ~ ` ~ ' F $ Amount <br />~ ` Date ~ Written/Informal ` <br />. <br />x <br />. , <br />, ~ :~ <br />, , <br />, <br />, <br />~ <br />~ <br />; ' , ~ <br />, . ,. <br />~, a~ <br />~ <br />.., . ~ . . ' r '. ~;, 1 <br />1 y <br />` <br />- ~ .. , . ..~.:_ ,.- , w.!~:>~ ... . -x ....' ::....,.., t <br />~ s '-y I + 4t _;N I f <br />a <br />t '~ 4 <br />" ' ' <br />.. <br />p j~ <br />r . <br />S f <br />^ <br />- <br />a <br />t~ <br />t <br />c <br />Public Bidding <br />ch Re <br />and Bid Cover. Sheet : <br />Att <br />ap Shee <br />t <br />, ~ <br />, <br />, M. . T~, <br />, . : , . ~ t. ~ <br />~ , ,. , <br />-~ . ,. ,, _,Y i ~~; } . ~' <br />, BUDGET ' , CURRENT FY~ ~' ` ; { ;~. ` n ~ " ` <br /> <br />SUBSEQUENT <br />F~Y <br /> <br />~ <br />, ,, ,. <br />,. <br />...~-.'.' '. ~ : ,. ..:. ~:' S".'., k .,~,. ~ 4 <br />Accounts.Affected '~~ ~ $ ' ~ k $ <br />* $ ~: ~ ~ ~ r ~ ~ ~~ $ ~~ <br />: <br />` <br />~ ~ : <br />, <br />Y <br />` , <br />r ~ <br />~ ,. <br />R! <br />Previous Board <br />1 ^ Gran <br />Action : Date' <br />t .:# <br />, <br />: , .. ~~ <br />. , <br />- , < <br />~ , <br />' <br />~ <br />. 0 Revenue Contract <br />~, <br />~ ~„ F_: ~ <br />; <br />~ ^:Non Financial Agreement , <br />, <br />; <br />~... . : ~ <br />Insurance Certificate Attached~ ;: ^ Yes r ~,No ':` N/A ~ ~ Performance'Bond Attached~ : ^ Yes ^ No <br />f° , s . ~ <br />~ 'L(•N/A <br />. <br />. .... ,.~. <br />~.: ;.;: . ~s;: ~'.: :, -.: . . . :.:;. ~. , :. ,,. _ . . <br />FOR .LL DATE: FORINARDED FOR SIGNATURE ' ' `~""~ ~~4. z`: '_ ~ ~ .' DATE RETURNED '~ <br />~, . APPROVALS , r. - „ a . ;;, <br /> <br />. <br />GAO , . . . ; <br /> <br />,_ >. <br />. , ., > _ . , .. E <br />: .... .: _ , <br />USE ' Legal,Gounse ~K ~--..Date Budget & Research Date <br /> <br /> <br /> <br /> <br /> <br />Q ° <br /> <br />~J~ ~.Cr ~r ~~n,C. ;: ~ ~4 -~ `~ .. _ _ ~ Date . _ <br />ONLY ~, Risk Mgt Date /` Co Admm , ~' ~. <br />., 10 >.~l ~ .: <br />,. . , . . ,: <br />To tie completed by Finance ATTENTION:DEPARTMEN'fS This contract~is encumbered unde~_the PYMT CONTROL #. and ACCOUNT # s and` ; <br />.. . <br />the;$;AMOUNTS.~shown"below -All, a ments must be rocessed under:this PYMT,C ~ ~ ~ <br />„ . . P Y R . ONTROC' # „ , £ <br />. .. .. _ .~. . ~.<. __ ...... . . .. .. . ... . . r. ,. .., ...., e_..,' ... . . . ... .. , ,. . ...~R .. - <br />REF/CONTRACT #'_ <br />: REF DATE ' <br />AEV.. 1/69 ' ~ ~ <br />