HomeMy WebLinkAboutDispositions Forms_57-21_11/5/2021_UtilitiesNO. 57-21
RECORDS DISPOSITION DOCUMENT
PAGE 1 OF 1 PAGES
1. AGENCY NAME and ADDRESS
2. AGENCY CONTACT (Name and Telephone
VILLAGE OF TEQUESTA
Number)
345 Tequesta Drive
Lori McWilliams, MPA, MMC, (561) 768-0443 or
Tequesta, FL 33469
Mary Ann Grieser, CMC, (561) 768-0445
3. NOTICE OF INTENTION: The scheduled records listed in Item 5 are to be disposed of in the manner specified
below (specify only one).
0 a. Shred at Department Level 0 c. Send to Storage until e. Recycle
Disposition Date Met
0 b. Send to Storage for Shredding Q d. Remove from Server 0 f. Other
4. SUBMITTED BY (Department Head/Senior Staff Member Only):
I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the
records ha a been fully justified, and that further retention is not required for any litigation pending or imminent.
Signature Name and Title (Dept. Head/Senior Staff only) Date
5. LIST OF RECORD SERIES
a.
Schedule
b.
Item
C.
Title
d.
Retention
e.
Inclusive
f.
Volume
g.
Disposition
No.
No.
Dates
in
Action and
Cubic
Date
Feet
(Completed After
Authorization
GS1-SL
64
Contracts/Leases/Agreements: Capital
10FYafter
contract complete
12/2000-09/2001
0.13
Improvement
102013
I
GS1-SL
64
Contracts/Leases/Agreements: Capital
1r
contraactctcomomplete
10/2001-09/2002
0.10
Improvement
10/2013
�)
GS1-SL
64
Contracts/Leases/Agreements: Capital
1ctcomr
contract wplete
10/2002-02/2003
0.01
Improvement
10/2013
GS1-SL
167
Environmental Regulation Compliance Records
5FY after project
complete
12/1996
0.01
10/2008
I
GS1-SL
167
Environmental Regulation Compliance Records
5 regoopmafter peteng
Permit expiration date is
0.01
10/2011
07/2006
�)
TOTAL
CUBIC FEET THIS PAGE:
0.26
6. DISPOSAL AUTHORIZATION: Disposal for
7. DISPOSAL CERTIFICATE: The above listed records have been
the above listed records is authorized. Any
disposed of in the manner and on the date shown in column g.
deletions or modifications are indicated.
Clerk's Office Signature Date
Signature of rs Dis o ing of Records Name/Titre- Date
Routin
:
1. Originates with Department Senior Manager, then
1. Originates with Department Senior Manager, then
2. Village Clerk's Office authorizes disposition, and returns to
2. Village Clerk's Office authorizes disposition and/or storage
3. Originating department to dispose and document column g,
at the storage room and will contact Public Works to remove
then sends
records
4. Completed form to Village Clerk's Office for permanent
3. Clerk's Office will be responsible for final disposition of
archival
records at this point
OR
Form Updated:9/21/21