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Certification <br />The attached contract: [check as many as apply] <br />❑ conforms to Dane County's standard Purchase of Services Agreement form in all respects <br />❑ conforms to Dane County's standard Purchase of Services Agreement form with modifications <br />and is accompanied by a revision copy' <br />® is a non-standard contract which has been reviewed or developed by corporation counsel and <br />which has not been changed since that review/development <br />❑ is a non-standard contract previously review or developed by corporation counsel which has been <br />changed since that review/development; it is accompanied by a revision copy' <br />❑ is a non-standard contract not previously reviewed by corporation counsel; it is accompanied by a <br />revision copy <br />❑ contains non-standard/indemnification language which has been reviewed or developed by risk <br />management and which has not been changed since that review/development <br />❑ contains non-standard insurance/indemnification language which has been changed since <br />review/development or which has not been previously seen by risk management; it is <br />accompanied by a revision copy <br />❑ contains non-standard affirmative action/equal opportunity language which has been reviewed or <br />developed by contract compliance and which has not been changed since that <br />review/development <br />❑ contains non-standard affirmative action/equal opportunity language which has been changed <br />since the earlier review/development by contract compliance or which has not been previously <br />seen by contract compliance; it is accompanied by a revision copy' <br />Date: 5 05 Signed:4�` <br />Telephone Number Print Name: -�-oc„ ,a .v,o�R•�rr£ <br />Major Contracts Review (DCO Sect. 25.20) This review applies only to contracts which both <br />exceed $100,000 in disbursements or receipts and which require county board review and approval. <br />Executive Summary (attach additional pages, if needed). <br />1. Department Head ® Contract is in the best interest of the County. <br />Describe any deviations from the standard contracting process and any changes to the standard <br />Purchase of Services Form Agreement. <br />Date: Signature: <br />2. Director of Administration ❑ Contract is in the best interest of the County. <br />Comments: <br />Date: Signature.- <br />3. <br />ignature:3. Corporation Counsel ❑ Contract is in the best interest of the County. <br />Comments: <br />Date: Signature: <br />A revision copy is a copy of the contract which shows the changes from the standard contract or previously revised/developed <br />contract by means of overstrikes (indicating deletions from the standard language) and underlining (showing additions to the <br />standard language). <br />Rev. 8100 <br />