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CONTRACT COVERSHEET NOTE: Shaded areas are for County Executive review. DEPARTMENT CONTRACTJADDENDUM #: Received Planning and Development Controller -s� Corporation Counsel 1. This contract, grant or addendum: M AWARDS ❑ ACCEPTS Risk Management Contract Addendum ADA Coordinator If Addendum, include Purchasing Agent County Executive please original contract number 2. This contract is discretionary 0 YES ❑ NO Q POS ❑ ❑ Co Lesse ❑ Co Lessor ❑ Intergovernmental ❑ ❑ ❑ 3. Term of Contract or Addendum: From: 1-1-12 To: 12-31-12 4. Amount of Contractor Addendum $4729.00 ❑ Purchase of Property 5. Purpose: ❑ Property Sale Small Business Access Line ❑ Other: ❑ 6. Vendor or Funding Source: Board of Regents of the UW -Small Business Development Center 7. MUNIS Vendor Code: 8290-2 8. Bid/RFP Number: 9. If grant: Funds Positions? ❑ YES ❑ NO Will require on-going or matching funds? ❑ YES ❑ NO 10. Are funds included in the budget? ® YES ❑ NO 11. Account No. & Amount, Org. & Obj. PDPLNDIV 32675 Amount $ 4729.00 Account No. & Amount, Org. & Obj. Amount $ Account No. & Amount, Org. & Obj. Amount $ 12. Is a resolution needed: ❑ YES O NO If "YES," please attach a copy of the Resolution. If Resolution has already been approved by the County Board, Resolution No. & date of adoption 13. Does Domestic Partner equal b efits requirement apply? ❑ YES D NO 14. Director's Approval CONTRACT REVIEW/APPROVALS Initials Received Controller Corporation Counsel Risk Management ADA Coordinator Purchasing Agent County Executive Footnotes: 2 Ftnt Date In Date Out Z -- -z— 3 z z 3 Z L /i lz VENDOR Vendor Name & Address UW Small Business Dev Ctr 975 University Avenue Madison WI 53706 Contact Person Mike Hardiman Phone No. 262-0063 E-mail Address Return To: Name/Title: Karen Pribbenow Dept.: Planning and Development Phone: 2664251 Mail Address: Room 116, CCB E-mail: Pribbenow@countyofdane.com 012-47 (11/08)