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COUNTY OF HARNETT
DOCUMENT REVIEW FORM VERSION 2023.7.1
↓ THIS BLOCK TO BE COMPLETED BY DEPARTMENT↓
CUSTOMER/VENDOR INFORMATION
Customer/Vendor Legal Name: Customer/Vendor Number:
Customer/Vendor Contact Name:
Email address: Phone number:
CONTRACT INFORMATION
Enterprise ERP Contract Number: Contract Period: from to
Type of Contract: New Renewal Master Multi-Year Change Order Revenue
Purpose of Contract: Goods Services Software Consulting Construction Lease
Other:
Description/Scope of Work:
Funding Source: County State Grant Federal Grant Local Grant Financed Other:
Payment Terms: Monthly Quarterly Annually Other:
Contract Value per Fiscal Year: Original Change Revised
Fiscal Year: Amount:
Fiscal Year: Amount:
Fiscal Year: Amount:
Fiscal Year: Amount:
Fiscal Year: Amount:
Extension Options:
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COUNTY OF HARNETT
DOCUMENT REVIEW FORM VERSION 2023.7.1
ACCOUNTING INFORMATION
Expenditure/Revenue Accounting Code(s):
Org Object Project Task Sub-Task Job
Budget Amendment MUST be attached if needed
Budget Amendment Number: Date Released:
Department Head has reviewed attached document and is satisfied with material terms
Department:
Contract Administrator: Telephone:
Date Needed: Board Meeting Date Requested:
Department Head Signature: Date:
PROCUREMENT OFFICE
Date Received:
Comments:
Signature: Date:
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COUNTY OF HARNETT
DOCUMENT REVIEW FORM VERSION 2023.7.1
INFORMATION TECHNOLOGY OFFICE
Comments:
Signature: Date:
COUNTY STAFF ATTORNEY’S OFFICE
Comments:
Signature: Date:
RISK MANAGEMENT OFFICE
A copy of the Certificate of Insurance has been received and verified. YES NO N/A
Comments:
Signature: Date:
FINANCE OFFICE
Comments:
Comments:
Comments:
Signature: Date:
COUNTY MANAGER’S OFFICE
Comments:
Signature: Date:
CLERK TO THE BOARD OF COMMISSIONERS
(AGENDA REQUEST FORM MUST BE ATTACHED IF BOARD ACTION IS REQUIRED)
Comments:
Signature: Date: