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CONTRACT COVERSHEET <br />NOTE: Shaded areas are for County Executive review. <br />DEPARTMENT <br />NDUM- #: <br />CONTRACT/A7(6 <br />Date Out <br />Planning and Development <br />o� <br />1. This contract, grant or addendum: a AWARDS ❑ ACCEPTS <br />Contract Addendum <br />2 lg 1 <br />_A Corporation Counsel <br />If Addendum, please include <br />original contract number <br />/I D <br />Yi Risk Management <br />2. This contract is discretionary 0 YES ❑ NO <br />Cl POS <br />❑ Co Lesse <br />❑ <br />❑ <br />3. Term of Contractor Addendum: From: 1-1-10 To: 12-31-10 <br />L <br />❑ Co Lessor <br />❑ <br />= t <br />4. Amount of Contractor Addendum $4850 <br />❑ Intergovernmental <br />❑ <br />❑ Purchase of Property <br />5. Purpose: <br />❑ Property Sale <br />SBDC Business Answer Line <br />❑ Other: <br />❑ <br />6. Vendor or Funding Source_438e—/.?3 V_ <br />7. MUNIS Vendor Code: <br />8. Bid/RFP Number: <br />9. If grant: Funds Positions? ❑ YES ❑ NO Will require on-going or matching funds? O YES ❑ NO <br />10. Are funds included in the budget? Cl YES ❑ NO <br />11. Account No. & Amount, Org. & Obj. PDPLNDIV 32675 <br />Amount $ 5,000 <br />Account No. & Amount, Org. & Obj. <br />Amount $ <br />Account No. & Amount, Org. & Obj. <br />Amount $ <br />12. Is a resolution needed: ❑ YES O NO If "YES," please attach a copy of <br />the Resolution. <br />If Resolution has already been approved by the County Board, Resolution No. & <br />date of adoption <br />13. Does Domestic Partner equal bene s requirement apply? ❑ YES O NO <br />�-Ec <br />14. Director's Approval - - I/ <br />V <br />CONTRACT REVIEW/APPROVALS <br />Initials <br />Ftnt Date In <br />Date Out <br />Received <br />� <br />Controller <br />2 lg 1 <br />_A Corporation Counsel <br />/I D <br />Yi Risk Management <br />ADA Coordinator <br />L <br />Purchasing Agent <br />'21n z-ot0 <br />= t <br />County Executive <br />Footnotes: <br />VENDOR <br />Vendor Name & Address <br />975 University Ave, Room 3260 <br />Madison WI 53706 <br />Contact Person <br />Neil Lerner, Director <br />Phone No. <br />608-263-0221 <br />E-mail Address <br />nslerner@wisc.edu <br />Return To: Name/Title: Karen Pribbenow Dept.: Dane Co Ping & Dev <br />Phone: 266-4251 Mail Address: Room 116, CCB <br />E-mail: pribbenow@co.dane.wi.us <br />012-47 (11/08) <br />