HomeMy WebLinkAboutPW & U ADMIN - 06/01/2015 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 ihan "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)).
Lega(Disposition Authority(taken from Records Retention Schedule) Agenty Retords
Description Date Method of
Records Series Title Records Series Records Retention Minimum Retention Period (Box/Item numbers, Dates Covered Minimum Destruction(See
DAN Schedule volume,etc.) Re�iion examples below*)
Authorizations/ GS50-01-42 Local Retain for 6 years after Operating Valid through May 2009 �1�5 In-house
Certifications– Rev. 1 Government authorization superseded or Permit(1 page) fo/i//�C shredding
Agency (CORE)Version terminated and conditions of
Management 3.1 authorization satisfied and
violations(if any)corrected
then Destroy.
*Examples of inethods 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 sub%ect to ongoing or reasnnob/y anticipated litigation or
public records requests, 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:
Employee Signature: Printed Name: N I I II�C U I I�JI�� I� � Division:l a' � � "1"1C]� Y 1��
The Records Manager must sign e approval of this request prior to the destruction of the listed records:
Records Manager Signature: Printed Name: � "�n� Date Approved: �� ��` J
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Name: 1 l.�t� 1 r ►1 I 1�� ` Date Records Destroyed: � I ( I �S
—�
Vendor Business Name(if used): Phone:
Form Revised OS/06/2014
City of Bremerton Public Records Destruction Log
Vendor Signature: 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 G550-09-06.
Form Revised OS/06/2014