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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 and is accompanied <br />by a revision copy' <br />❑ is a non-standard contract which has been reviewed or developed by corporation counsel which has been changed <br />since that review/development <br />❑ is a non-standard contract previously reviewed or developed by corporation counsel which has been changed since <br />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 revision copy <br />❑ contains non-standard/indemnification language which has been reviewed or developed by risk management and <br />which has not been changed since that review/development <br />❑ contains non-standard insurance/indemnification language which has been changed since review/development or <br />which has not been previously seen by risk management; it is accompanied by a revision copy <br />❑ contains non-standard affirmative action/equal opportunity language which has been reviewed or developed by <br />contract compliance and which has not been changed since that review/development <br />❑ contains non-standard affirmative action/equal opportunity language which has been changed since the earlier <br />review/development by contract compliance or which has not been previously seen by contract compliance; it is <br />accompanied by t <br />revi yon copy' <br />Date: A, 9 LX[ 2 Signed: <br />Telephone Number: 608-266-4252 Print Name: Daniel Frick <br />MAJOR CONTRACTS REVIEW (DCO Sect. 25.20) This review applies only to contracts which both exceed <br />$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 Purchase of <br />Services Form Agreement. <br />Date: <br />Signature: <br />2. Director of Administration ❑ Contract is in the best interest of the County. <br />Comments: <br />Signature: <br />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 contract <br />my means of overstrikes (indicating deletions from the standard language) and underlining (showing additions to the standard language). <br />Rev. 8/00 <br />