HomeMy WebLinkAboutCounty Document Review Form 2022.7.1 (003)v
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COUNTY OF HARNETT
DOCUMENT REVIEW COVER SHEET VERSION 2022.7.1
↓ 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: Contract Period: to
Type of Contract: New Option to Renew Auto Renewal Multi-Year
Purpose of Contract: Services Goods 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:
Does this document include the use of another entity’s Land, Building or Equipment? Yes No
If yes, please explain in detail.
Contract Value per Fiscal Year:
Fiscal Year: Annual Amount:
Fiscal Year: Annual Amount:
Fiscal Year: Annual Amount:
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COUNTY OF HARNETT
DOCUMENT REVIEW COVER SHEET VERSION 2022.7.1
Fiscal Year: Annual Amount:
Fiscal Year: Annual Amount:
Extension Options:
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:
Department Contact: Contact Telephone:
Date Needed: Board Meeting Date Requested:
Department Head Signature: Date:
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COUNTY OF HARNETT
DOCUMENT REVIEW COVER SHEET VERSION 2022.7.1
PROCUREMENT OFFICE
Comments:
Signature: ____________________________________ _____ Date: _______________________
COUNTY STAFF ATTORNEY
Received by: Date Received:
Comments:
Signature: ____________________________________ _____ Date: _______________________
FINANCE
Comments:
Signature: ____________________________________ _____ Date: _______________________
COUNTY MANAGER
Comments:
Signature: ____________________________________ _____ Date: _______________________
CLERK TO THE BOARD OF COMMISSIONERS
(AGENDA REQUEST FORM MUST BE ATTACHED IF BOARD ACTION IS REQUIRED)
Comments:
Signature: ____________________________________ _____ Date: _______________________
RISK MANAGEMENT
Risk Management has received a copy of the Certificate of Insurance and verified it. YES NO
Comments:
Signature: ____________________________________ _____ Date: _______________________