HomeMy WebLinkAboutMINUTES - 09182007 - C.11 To: BOARD OF SUPERVISORS
VEHICLE AND EQUIPMENT REQUEST FORM
(See Instruction Sheet)
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Department : Date: 7 Z o
Authorized Signature: Telephone:
Printed Name: MIC-#,4-E4-
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1. Reason and justification for vehicle request: Qd Sd a7-7f-
2.
7-7f-2. Funding Source: (Budget information will be used to prepare Board Order): '0,-e G- ?3C o
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Is an appropriation adjustment needed? ❑ Yes c2f-No
Fiscal Officer: Name: (54o26-j6-' Telephone:
3. Description of vehicle or equipment requested (If applicable, complete an accessories form): zoo
Qu #-,u r 14 6
4. Is an alternative fuel vehicle acceptable? ❑ Yes 99 No
If no, reason clean air vehicle will not work:
5. If replacement, which vehicle or equipment is being replaced: Type: / ?A0 144. iG�f jyt 4,9-64 �
Vehicle/Equipment Number: Odometer/Hours:
6. Reason purchase cannot wait until next budget cycle: C�r/� .S' ��Pd� c�E 4-r4"•4
7. CAO Release to GSD EI et2an�[geme t: Yes ❑ No Date: 7 .�� 07
CAO Signature:
FOR GSD FLEET MANAGEMENT'S USE
1. Is vehicle/equipment an addition to the fleet? ❑ Yes EK No
2. If vehicle/equipment is for re lacement, an inspection/evaluation to be completed by Fleet Manager:
Date Inspected: O' 0 17
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Vehicle/Equipment: Make: CCG u,UG Model: Year:
Condition of vehicle and/ equip ent and life expec ncy: DG�T"
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Accumulated Depreciatiolln::�� ill Estimated Salvage Value:
Estimated Cost of Reque �2�. Coo
3. Fleet Manager Signature: Date: � '�
C':\Documents and Settings\fmorgan\Local Settings\Temporary Internet Files\01..K1 I\ADMIN BULL 508 FLEET ACQUISITION FORM.doc 12/12/01