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COUNTY OF HARNETT
DOCUMENT REVIEW COVER SHEET VERSION 2019.1.22
Received by Legal Services:
Date:
By: Document Control Number:
↓ This block to be completed by Department↓
VENDOR INFORMATION
Vendor Legal Name: Vendor Number:
Vendor Contact Name:
Email address: Phone number:
CONTRACT INFORMATION
Munis Contract Number:
Type of Contract: New Renewal Continuation Year of
Purpose of Contract: Services Goods Consulting Construction Lease Other:
Description/Scope of Work:
Initial Contract Period: to
Funding Source: County State Grant Federal Grant Local Grant Financed Other:
Payment Terms: Monthly Quarterly Annually Other:
Revised 07.01.2021
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COUNTY OF HARNETT
DOCUMENT REVIEW COVER SHEET VERSION 2019.1.22
Expenditure/Revenue Org-Object-Project Accounting Code(s):
Contract Value per Fiscal Year:
Fiscal Year: Annual Amount:
Fiscal Year: Annual Amount:
Fiscal Year: Annual Amount:
Fiscal Year: Annual Amount:
Fiscal Year: Annual Amount:
Termination Date:
Extension Options:
Does this document include the use of another entity’s Land, Building or Equipment? Yes No
If yes, please explain in detail.
Budget Amendment MUST be attached if needed
Department:
Contact Telephone:
Date Needed: Board Meeting Date Requested:
Department Head has reviewed attached document and is satisfied with material terms.
Department Head Signature: Date:
Revised 07.01.2021
Contact Name:
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VERSION 2019.1.22
PROCUREMENT OFFICE
Comments:
Signature: ____________________________________ _____ Date: _______________________
RISK MANAGEMENT
Risk Management has received a copy of the Certificate of Insurance and verified it. YES NO
Comments:
Signature: ____________________________________ _____ Date: _______________________
COUNTY STAFF ATTORNEY
Comments:
Signature: ____________________________________ _____ Date: _______________________
FINANCE
Comments:
Signature: ____________________________________ _____ Date: _______________________
COUNTY MANAGER
Comments:
Signature: ____________________________________ _____ Date: _______________________
CLERK TO THE BOARD OF COMMISSIONERS
(AGENDA REQUEST FORM MUST BE ATTACHED)
Comments:
Signature: ____________________________________ _____ Date: _______________________