HomeMy WebLinkAboutPOLICE - 05/12/2015 City of Bremerton Public Records Destruction Log
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The purpose"of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved rninimum 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 o[her 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 Loca/Government Records Retention Schedule(COREJ).
legal Disposition Authority(taken from Records Retention Schedule) � Agency Records
Descript(on Date Method of
Records Series Title Records Series Records Retentlon Mfnimum Retentfon Perlod (Box/Item numbers, Dates Covered Minimum Destructlon(See
DAN Schedule volume,etc.) ReMeL°� .examples below')
3/17/15 to �W �,�`, 07-009700 to 9/5/2007 to 5/1/2008 Outside
5/1/2015 ��l+—�,� ��A-��� 7 Years 08-004999 ��J,5 Contractor
►tfCG( Shredding
5/8/15 �� ��� 7808620 to 9/1978 to 7/1980 � I n�v� Outside
��IL'�+� 20Years 80-7261 • 0 '�'`~V Contractor
� ���t, Shredding
*Examples of inethods of destrucfion:electronic deletion,in-house OR outside contractor shredding,secure recycling,other(describeJ
Statement: The public records listed above have met their minimum retention period(s), are not subject to onqoing or reasonably anticipated litigation or
public records repuests, are not needed for audit or other agency business, and shall be destroyed.
The individual responsible for inventorying the listed records must sign below prior to the Record's Manager approval:
Employee5lgnature: � � �(,��PrintedName: �I'IYIG�_ i��1�(.lil.✓l Division: ����
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signature: Printed Name: ��J ��(/i�� Date Approved: -�/�� !f�
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature:��/"/ - Printed Name���-� .�� ���� Date Records Destroyed: .J/���� -
Vendor Business Name(if used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention ond disposition action for this Public Records Destrudion Log is"Retain for the life of the agency"pu�suant to CORE series G550-09-06.
Form Revised 05/06/2014
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�Lc l�llcl� MoI'ilG CERTIFICATE OF DESTRUCTION
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y� ��j/����d�`�������% � 2910 Hogum Bay Rd ���a �o
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����G �� � � Olympia Wa 98516 o x
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E-Mail: ims@wcnx.org � • �
Name: CO OP POLICE-BREMERTON Phone: 1-877-898-0112 , ''
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Address: 1025 BURWELLST Fax: 1-360-486-2467 °'1�� �,o`�
City: BREMERTON , 98337 ,
Phone: 360-473-5237 Account#: 2185-g52778-700 Route Id: SN92
Request: MS-LT. OLAN Invoice Date: 5/12/2015 Invoice#: 1158605
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
Notes: 2.12.15 SERVICE 5-65GL BINS TODAY, CALL 360-473-5221 BEFORE SERVICE SO HE CAN
' ASSIST YOU.
Service Description Qty Rate Amount
65SC 5.00 65 GAL SHRED CART �_ 2.77
Driver Signature: �i�'l��l Date: ��/Z.�/S Truck
Customer Signature: .� Date: ��. � Time