HomeMy WebLinkAboutRISK MANAGEMENT - 09/02/2014 City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention
periods before being destroyed pursuant to RCW 40.14.070, WAC 434-610.070, and WAC 434.640.010, -020, and -030. Please fill out this form when destroying public records
whose minimum retention is other than "Retain until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retention
Value"section of the Local Government Records Retention Schedule(CORE)).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method of
Records Series Records Retention Minimum
Records Series Title DAN Schedule Minimum Retention Period (Box/Item numbers, Dates Covered Retention Destruction(See
volume,etc.) Met examples below*)
Insurance Policies GS50-06C-16 CORE Agency 6 years after termination or 1 Banker Box 1986-1995 2001 Secure recycling
Purchased Rev. 1 Mgmt-Risk expiration of coverage
Management/
Insurance
Insurance,Audits, GS50-06C-15 CORE Agency 4 years 1 Banker Box 1986-1995 1999 Secure recycling
Surveys, Reports Rev.0 Mgmt-Risk
Management/
Insurance
*Examples of methods of destruction:electronic deletion,in-house OR outside contractor shredding,secure recycling,other(describe)
Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonably anticipated litigation or
public records requests, are not needed for audit or other agency business, and shall be destroyed.
The individual responsible for inventorying t listed records must sign below prior to the Record's Manager approval:
Employee Signature: �, !� Printed Name: /Gf fir' ��Lf�(�liY? Division: /�
The Records Manager must sign the approval of this request prior to the destruction of the listed records: ` p
Records Manager Signature:�T C_._ Printed Name: R�� L-,kfod Vic rr Date Approved: 1 Z
The person/people responsible for the clestruct'&of records must sign upon destruction of the listed records:
- L
Employee SignaturelN:\ �U Printed Name: 1 / �c 16Q_//`'Z 2// Date Records Destroyed: 6 �� I
�!f�
Vendor Business Name(if used): a-a ^ � t��� r%✓\ Phone:
Vendor Signature: /rt Printed Name: Date Records Destroyed:
The retention and disposition action for this Public Records Destruction Log is"Retain for the life of the agency"pursuant to CORE series GS50-09-06.
Form Revised 05/06/2014