HomeMy WebLinkAboutPARKS & REC - 03/29/2016 1�'! �� ���;'(� CERTIFICATE OF DESTRUCTION
y � � / �FOR INF� ��
�����j ��// �G 2910 Hogum Bay Rd .��� �
�''�j j���%i���%��%�% Olympia Wa 98516 �oP 'Z
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Name: CO OP BERMERTON PARKS Fax: 1-360-486-2467 �o , �c
Address: 680 LEBO BLVD ''��iy� ao`
City: BREMERTON , 98310 • -
Phone: 360-473-5305 Account : 2185-952778-926 Route Id: SN92
Request: MR-MS-CORINNE Invoice Date: 3/29/2016 Invoice#: 1207854
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
Notes: 3/29 PURGE 56 BOXES. $3.26 EACH. OK TO BILL. HOURS 9AM-5PM
Service Description ` � Qty Rate Amount
SHPURGE 1.00 SHRED ONE TIME PURGE 3.26
S3 �oX ,
Driver Signature: � Date: Truck
Customer Signature: ,. Date: Time
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verlfying 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 fifl out this form when destroying public records
whose minimum retention is other than "Retaln until no longer needed for agenry business then destro�' (such as records covered in the "Records with Minimal Retention
Vatue"section of the Locol Government Records Retentlon Schedule(CORE)).
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•Examples of inethods of destruction:electronic deletion,in-house OR outside contmctor shredding,secure recyding,other(descriae)
Statement: The pub/ic records listed above hcve met their minimum retentlon period(s), are not subJect to ongoing or reasonably anticipated litlgatlon or
public recorcls requests,are not needed for audit or other aqency business,ond shal/be destroyeal.
The individual responsible for inventorying the listed recorcls must sign below prior ta the Record's Manager approval:
Employee Signature: r w� PNnted Name: ���Y�� ��� Divislon: ���t�S j �-L�'��'�r ��
The Records Manager must sign the-approval of this request prior to the destruction of the listed records:
� l�, ,,1 I /
Records Manager Slgnature:�J�`�.�/���V Printed Name: `�s,l�u�� �FJ��- Date Approved: � `� �CI �/�
Trie person/people responsible for the destruction of records must sign upon destruction of the iisted records:
Employee Signature: _ P�inted Name: Date Records Destroyed:
Vendor Business Name(ff used): Phone:
Vendor Signature: Printed Name: Oate Records Destroyed:
The reterttlon and disposJtlon adion far this Pubrc Records Destructfon Log is dRetain for the life of!he agency"pwsuant to CORE series G550-09-06.
form Revised 05/O6/2014
City of Bremerton Public Records Destruction Log
�
The purpose of this form is to document compliance and reasonable accountability by verifying that speciftc 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 flll out this form when destroying public records
whose minimum retention fs other than "Retain until no longer needed for agency business then destro�' (such as records covered in the "Records with Minimal Retention
Value"section of the Loca!Government Records Retention Schedule(CORE)).
legal Disposition A�thority(taken from Rewrds Retention Schedule) Agen Records
Reeords Series Records Raterrtlon �escrption �� Method of
Records Series Title DNd Schedule Minlmum Retention Pertod (Box/Item numbers, Dates Covered Mtnimum DestrucLton(See
volume,etc) R��on examples 6elow')
�nax�c'o�,� c�s 2�ot t - � ye�s ar+e.i2 dfa��y cs�cc�. �v+s�d�.¢,
-r.r�.v�sac-t�pns ��,� iReV Z C;�Y�E e�d o.�' -�Sca�.� �"�`'`�`�`S �� � � �� - �13c�� 01 1/ 1/D� c,���ac-ttiv�
ra►�1 • a.nd W.�C4.i SVt�f�.Qc�d�lh
p�t�cic�e. ySSp-t8- -� �epuQs a�-te.r� sPr°``� o�-ts�ol.�
ciePlicA-t�oi.�. 43 ►2ev � �IQ� d0.t+� a� 1icc��i ��°'�S 1�1�110 —2C�05 if 1 � l�j c�nt+r-ac.tort
SV�-�Ke�cL+cl.1Y1
't1n� �d5f C�sS�o-o3 - r�o+ used -ror� payYto�� o�tstict.c,
�rn%�..e,s1�Rlt.-ts o�1 rie�.,.� ��E RQ.-4t�R?�cn�¢.n-� wo►QKs►�- �! � /�- ��-131 ! l l�/� c�ontra�tod2
v ion - s�.�aedd i n
"Fxamples of inethods of destructlon:electronlc deletlon,in-house OR outslde controctorshredding,secure recyding,other(describe)
Statement: The public records listed above have met their minimum retentlon period(sJ, are not subject to ongoing or reasvnably anticipated litigation or
publlc records requests,are not needed for audlt or other agency business,and shall be destroyed.
The individual responsible for inventorying the Ilsted records must sign below prfor to the Record's Manager approval:
� � ' 1 1` ,, ' ,n���2CZ."�"� C�V�.
Employee Sfgnature: ��/I_/_Yl_/1_ D �A�1w.�t./��P�inted Name: ������ �`'� �C. Division: P�� � �`�"��` _
The Records Manager must si e approval of this request prior to the destruction of the listed records:
,�\ 1n�n,�n '/�1 �
Records ManagerSignature: Printed Name: � )�.r`U�v '1 \ ��I �� DateApproved: � f
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Slgnature: Printed Name: Date Records Destroyed:
Vendor Business Name(if used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retentlon and disposltion actlon for this Publlc Records Destruction Log is aRetain for the life of Lhe agency"'pursuant to CORE series GS50-09-06.
Form Revised OS/06/2014
City of Bremerton Public Records Destruction Lo�
The purpose of tflis fortn ts to document compliance and reasonable accountabtltty by ver(fytng that spedflc publlc records have met current, approved mintmum retentton
periods before being destroyed pursuant to RCW 40.14.070.WAC 434610.070.and WAC 434.640.010.-020,and-030.Please flll out this form when destroying publtc records
whose mtntmum retention is other than "Retafn until no tonger needed for agenry business then destro� (such as records covered tn the "Records with Mintmal Reteritlon
Value"section of the Loca!Government Records Retentlo Schedule(COREJ).
Legal Dispos[tlon Authority(taken from Records Retentlon Schedule) Agen Records
Raoo�ds Serias Reoords Retentlon ���°D � Method of
Remnis Se�les 71tla � Sehedute Minlenum Reterrtton Pe�iod (Box/item num6ers, Dates Covared �� QesduQlon(�e
volume,etey e�tinPles bel�
�tn4rtU ovl GS�11- Met
;v�ax�sac-t iorbS ��4 �v 2 C'ORT � ��S �t2iR d,A.1! Catsl�, pV{�s 1
�.a,ra.� . er,d oF�s�.ar ���s (�t t ��to- �2131/�(.o t 1 tl�3 c�r�trac��u�
sh.l�e.ddin
F u���a.I �s2o�t_ (� y�s �te� Recef ou+sid,e.
-�ra.hsac-�r o ns t�,� Rev 2 CA�RE e,nd of'�s oa,1 y�eo�,rZ boo4cs 1 l J to J i�1- 2/ t/�5 l/ 1/1a. c,�►�+t�ro�c-tort
°1'� Red i
Ft�ou,ua.f t�s2��t- � �e.a,�es o�}e�R da�� c��. �}s�at�¢, .
� e�.r.s¢x�i.a�� �$`� RevZ. �A 1 R E � �. -F,'sca,f b�«aR {'�t r'�r+�+t°t't s sla)t�'�I - °t/ts!ti`I �/t 1 �! cAn+rCtc+o�2
� � �� S s dcL(n
•F�omples of ined�ods of destrucdon:e/ecimnlc deletlor�In house OR outslde contractorshreddln8,secure recydlna o0her(desalbeJ
Si+atement: The public records llsted above have met thelr mfnlmum r�etenHon peHod(sj, ore not subJect to ongolnA or reasonably anticipated lltlgotlon or
publk recoMs requests,are not needed�r oudk or other ageecy buslness,and shall be destroyed.
The individual responslble for inventorying the Iisted rewrds must stgn below prlor to the Record's Manager approval:
. •
EmployeeSfgnature:����vv VW�,� pr►rrtedHame� ��@.1Y1.��i W�� D1vislonL��� r�,ec�ea-�iov�,..
The Records Manager must sign e approvai of t ts request prior to the destructton of the Ifsted records:
.
Records Menager Stg�ature: PrirKed Name: �.�I t(�i'�11[)k �vl'i K Date qpproved; / /• ����S
The person/people responsibte for the destruction of records must slgn upon destructfon of the Iisted records:
Employee Slgnature: Printed Name: Date Reaords Destroyed:
Vendor Buslness Name(if used): Phone:
Vendor Slgnature: Printed Name: Dabe Records Destroyed:
The retentlon and dlspasltlon acHon fior thls Publlc Records DestruWon Log!s"Retoin fior the 11j�e of the ogenc�r'purnmnt to COREser/es GSSO-09-06.
forin RevTsad 05/86/2014
City of Bremerton Public Records Destruction Log
The purpose of this form fs to document compliance and reasonable accountability by verifying that specific publfc records have met current, approved minlmum retention
periods before befng destroyed pursuant to RCW 40.24.070.WAC 434610.070,and WAC 434.640.010,-020, and-030. Please flll out thls form when destroying public records
whose m(nimum retentlon Is orher than �Retaln until no longer needed for agenry business then destro}r' (such as records covered in the "Records with Minimal Retention
Value"sectfon of the Local Government Records Retentlon Schedule(COREJ).
Legal Dlsposltlon Authority(taken from Records Retention Schedule) Agenry Records
Records Series Records RetenUon Description Minlm�m Method af
Records SeNes Tltle DAN Sehedule Minimum Reterrdon Period (Box/Item numbers, Dates Covered Destructlnn(See
wiume,�) R M�OO examples below•)
zns� io - �aS�o�2- c� �axS a�-t1t.r �taygrcx.,�d fl �
R�uta O3g CA r�E o� c�a.lA nda,e 1°I�la- 200 rj 1��/pZ c,�n-�ac-t oa
Novl P.�lv�r01'1 1R2v O aund ; Gt i �n$�,C�i��S
f��a,�ncu a-� ys 20�1- � y-eo�.�s 4F-t�e,R gex�ka.l ow�ct,c
�r�sac-hor� t8�1 ��'Z CA�� ertd oFfiScoU �.Ye�ta2 clovcr►S�� I 2./q 3 - 12,/2�00 ��� �07 c,o���
.F�r cLr�c:+cfu1 . GS 2o t t - l�r c,�e,�,�s c�t� � �,mow�}. au'�'
.�v�a,►�,sac�ons i3�1 �ev Z COl'QE e�e c� �isc� yec� ��c,s�. 1��I�t�s"�2/�)�n7 t/ il ly ��d��
'Examples of inethods of destructlon:electronic deletlnn,In-house OR outslde contractor shredding,secure recycling,otber(descNbeJ
Statement: The pub/ic records Ilsted above have met their ni'fNlmum retentlon period(s), are not subject to ongofng or reasonably anticipated IJtigation or
publlc records requests,are not needed for audlt or other agency business,and shall be destroyed.
The individual responsible for inventorying the Iisted records must sign below prlor to the Record's Manager approvai:
Employee Signature:���� A I 1�� Printed Name: ���I���.Q, w�"�, Divlslon: P�� 3 ��i ��
The Records Manager must sign the approval of thls request prior to the destruction of the listed records:
Records Mana erSi atur�� + / �L�rl�vl
B � ^. Printed Name: ��-y �(.�� n G'YI � DateApproved: �� � (F7
The person/people responstble for the destructlon of records must sign upon destruction of the listed records:
Employee Signature: Printed Name: • Date Records Destroyed:
Vendor Business Mame(ff used): Phone:
Vendor Signature: PMnted Name: Date Rernrds DesVnyed:
The retent)on vnd dlsposition action for thls Publlc Records Destrudlon Log is"Retaln for the lffe of the agencyu pursuant to COREserles G550-09-06.
Fortn Revised OS/06/2014
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 flll out this form when destroying public records
whose minimum retentfon is other than "Retain until no longer needed for agency business then destro�' (such as records covered in the "Records with Minimal Retention
Value"sectfon of the Loca!Government Records Retentfon Schedule(COREJ).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records " �
Descrlption Date Metfiad of
Records Series 79t1e Rewrds Series Rewrds Rate�Kion Mlnlmum Retentlon Perlod (Box/Item numhers Dates Covered Mlnlmum peS��Pon(See
DAN Schedule volume,etc) � R Met°n examples below•J
.��n a�r,ca cc.t , �S 2A 11- (,9 �,ax�.s a�,�z ��y � c u�Es�d�.
�v�aX�s ci.c-tt o��s CJ�I�E -��ax+sm,-Ho,� 511�'�3- g�3( )fl� 1�t� l l� c,or,��.c�ofs.
�c,l ►8'� rtevZ e�d � -flSc� c�e.�xz o.a�d r�e�c.e�Q�s sln.t�ectcf.�
fi nanc�c�,l - U S Z.vl�- cn �eLi.res c�-te�2 ��y c�.s�". o�-t s�ol.¢, � ._
�raxlso�c-tto ���t r�ev C�`(ZE. �„d, o� �isrs�,l �e� ��,a e e� 4 �l�'C°� - �/i S�02 1� ���°1 csw��d d R-
�i rio�.r�c.r oti.l C�S 2Al� - tA �.e,Ct�Q6 �-f�V� �'+��J ��^- ovEs�o�.�.
-t,raxisac-��ar� �8,� Rev 2 C�12r. ..�ransrn�}�a,1s �� � f�3- ►-Z 1 30 � O�j �J l/l� c.o�trac.-�ocz
2�d �F �'-csa�e.( o.�nd �c�e.�` s ��
"Examples of inethods of destructlon:electronlc deletlon,ln-house OR outslde contractor shredding,secure recyding,other(descrlbeJ
Statement: The public records Ifsted above hwe met their minimum retention perlod(sJ, are not subject to ongoing or reasonably ont/cipated litlgation or
public records requests,are not needed for audlt or other agency business,and shall be destroyed.
The individual responsible for inventoryfng the iisted records must sign below prior to the Record's Manager approval:
EmployeeSignature: Pl�� �_ [�)l�t_.�_�l�c.Pr(nted Name: WVe-IV��- t.U�� Division: �w1�1� �'S �-��Q����
The Records Manager must slgn the approval of this request prior to the destructlon of the Iisted records:
RecordsManagerSlgnature PrintedName:� �-6��� DateApproved: �'��' /�O
The person/people responslble for the destructlon of records must sign upon destruction of the listed records:
Employee Signature: Printed IVame: Date Records Destroyed:
Vendor Business Name(ff used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention and dfsposftion ac[ion fo�thls Publlc Records Destruction Lng is Retain for the life of the agenc�'pursuant to CORE series GS50-09-06.
Fortn Revised OS/06/2014
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 retentlon
periods before being destroyed pursuant to RCW 40.14.070,WAC 434610.070, 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 destro�' (such as records covered in the "Records with Minimal Retention
Value"section of the Locol Government Records Reteni/on Schedule(COREJj.
Legal Dlspositicn Authority(taken from Records Retention Schedule) Agenry fiecords
Deserlptlon Date Method of
Records Serles Title �CO�Series Records Retentlon Minimum Retention Period (Box/Item num6ers, Dates Covered �infmum Destructlon(See
DAPI Sehedule Retention
volume,etc) Met examptes below')
f-�n a.nc,►a.� y s 2p t t- lo �e�-�ts <.t�te.�e ���
sac-t�nns �B�l �ev ��.E � of fr�axl c�ea.�e. �ra.n���-�,l �f 1��p$ _�t�3p�� 1 J�/I�j co n�racfo�t
o�, und
�nax��t cc.� C�S ?.o lt- Co y�ct,res c�e�e dau�,y �r-tS t,�, outstds�.
�ra,nso�c-�to�t5 i8L-1 �ev C.OI'~Z�, -Erar�rnrtta-is 1/� /03 _ 1,2./31/D3 i I 1�1� c.on+►'+�.�2
e�-roL aF-fisc�l �ea,� �.Q,cei
fi nan c.5 04� GS 2r�it- �y �-e,a,�z,S qf-b2f2 d�x ty c�z.s� ou�si d�e,
��unsac-Hons ��►� ,Reu2 C,pl(��i end offtsGcef c�re -�v�`''sm'�-t+�-[ N 2�n'S- l2/31�D 1 jl f l2 �vn-���4
a, ' d. e�" s�.edaQ,crt
•Examples of inethods of destrudlon:electronlc deletion,in-house OR outside contractor shredding,secure rerycling,other(describeJ
Statement: The public records listed above have met their minimum retention period(sJ, are not subject to ongoing or reasonably anticipated litFqatfon or
publlc records requests,are not needed for audit or other agency business,and shall be destroyed.
The individual responsible for Inventoryfng the listed records must sign below prlor to the Record's Manager approval:
Employee Sfgnature:�,�}�/I O ��Lil.�Jl-�. Printed Name: ����Z� w�� Division: �a�� � ��-a'`}�E�l'L
The Records Manager must sign the pproval of request pflar to the destruction of the Ilsted records:
Records Manager Signature: Printed Name: � �1� _ Date Approved: ✓ ����[. K�
The person/people responsible for the destructfon of records must sfgn upon destruction of the listed records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor eusiness Name(if used): Phone:
Vendor Slgnature: Printed Name: Date Records Destroyed:
The retention and disposition action for this Public Records Destrudlon Log is"Retaln forYhe life of the agency'pursuant to COREserles GSSQ-09-06.
Form Revised OS/O6/2014
.�.n.�.,�..�-.� �. -- - --�.-.�� _.
City of Bremerton Pubiic Records Destruction Log
The purpose of this form fs to document compliance and reasonable accountability by verifying that speciflc pubUc 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 flll out thls 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 (n the "Records with Minimal Retention
� Value"section of the Loca!Government Records Retentfon Schedule(CORE)).
Legal Disposition Authority(talien from Records Retentlon Schedule) Agency Records
Records Serles Records Retention Descrlptlon MInI um Method of
Reeords Series Tltle DAN Sehedule Minimum Reterrtion Pefiod (Box/Item numbers, Dates Covered Rete[rtion Destructfbn(See
volume,etc) Met �mples below°)
�-t+�s cti o�s Us 2o t l- i� y e�c.+zs o�-�t a��y uxs k. , ou-�-s i�
�q 14i�I Rev 2 �I'�.� a� -Fi s c�x,l �,�-es� �ec.o(c�t�i a-�r 2�n � ��V� mh.�.ec1cL�n
fi nctrt ci M �S %At 1- l� �2�c.r� �f-�-eaR ��� ��- �u-t S 1 oLe,
-��.5'ac�i o nS �4�y 12ev �1�E aF -fi 5 ca.-1 �-�-� PieG° c1 1 t�o �jU Z l/L/O�j c:�n�rc�c,-ta,�
a.l �o s't�.�.cf d.�r�
�na.ric,�a,( . C�S 2o�t- f� c�c�-5 ctfte.�t dou ty c�u't... aufs�cs�e,
�v�S a�-�c o� ��3y REV 2 �Y�,� �-F�sca�.! �2 ���ia-1-�v <� 1/ ►�O7 s�-e.dcQ,�n
"Examples of inethods of des7ruction:electronlc deletlon,in-house OR outslde contractor shredding,secure recycling,other(describe)
Scatement: The public recvrds listed above have met thelr minimum retentlon perlod(s), are not subjed to ongoing or reasonab/y antfcipated lftlgation or
publlc records requests,are not needed for audit or other agency busfness,and shall be destroyed.
The indlvfduai responslble for inventoryingthe Ilsted records must sfgn below priorto the Record's Manager approval:
Employee5lgnature: ("Q�I���Q.�w��vPrinted Name: ��'���� w�� Dlviston: �� � ���-u{���' �
The Records Manager must sign approval of this request prior to the destruction of the listed records:
.
Records Manager Signature: PHnted iVame: �k ��� Date Approved: ✓ ���'l �
The person/people responsible for the destruction of records must slgn upon destruction of the Iisted records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor Business Name(if used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retentlon and disposition action for this Pub11c Records Destructlon Log Is nRetafn for the life of the agency"pursuunt to COR£series 6550-09-06.
Form Revtsed O5/06/2014
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountabllity 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"sertion of the Loca!Government Records Reientlon Schedule(COREJj.
Legal Dispositlon Authorfty(taken from Records Retention Schedule} Agenry Records
Desclptlon Date Meehod of
Reeords Series Records Reterition Mintmum
Records Series Tltle DAN Schedule Minimum Reeention Period (Box/Item num6ers, Dates Covered Retentlon ��uction(See
wlume,etc) Met examples below•)
*�YYt'C' � S C�50"�a � 1'1�0'f'V.SrCC� '�OY�' �Q�i�LO�� dV'fS�G��2'
-t�ri�+�¢.s1�er�.�s �y +R�o C��� ,�+i i�,errt�.��t ti W� w�p.Ks�.�s �J I 1�3- 12�3l � � �I� I o� con-+nacto�
C�i n
Ttrri�e.�.rc�s C�550-�3 - na+vSes=� forz �y�E1 �utsto�.
-r�v��z sv�Qa.tS �H ►�v� c,��'E �.-t��.e��++ � ,r,�o��cs� ,-ks 1 / 110�- 121311�`I 1 I�I Uq c�n-�v�-�o2
e,�w fi ccr-t�o v� ��
'��r`�-�- ,/ C�S 5�-03 ' ��.E �� ��' �y P0.c��O i 1 av�tSi d�2
Tiw�,e.S1tie,e.f5 n� �ev o �-S wo+�1�x. �/ 1 /n2-l 2�3 t�0 2 l I 1 J 0"� c�ti,-fr�ac+ori
vPX�i�i CCl-�'o✓� �
"Examples of inethods of destrudion:eledronic deletion,in-house OR outslde contractorshredding,secure recycling,other(descrlbe)
Statement: The public records listed above have met their minimum retention period(s), are not subject to ongoing or reasonab/y anticipated litigation or
public records reguests,are not needed for audlt or other agency busfness,and shall be destroyed.
The individual responsible for inventorying the listed records must sign below prfor to the Record's Ma�ager approval:
' l ' (.�QrG�'��-101rt�
Employee Signature��,���L��7�x Printed Name: ���. W�� Divisfon: ��_l'� �
The Records Manager must sign the approval of this reque.�t prior to the destruction of the listed records:
Records Manager Signature: Printed Name: ��r�� Date Approved: �'�� '` �
The person/people responsible for the destructfon of records must sign upon destruction of the ifsted records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor Business Name(if used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention ond dlspositfon action for thls Public Remrds Destructlon Log is�Retaln for the lJfe of the agenc�pursuartt to CORE serles G550-09-06.
Form Revised OS/06/2D14
City of Bremerton Public Records Destruction I.og
The purpose of this form is to document compliance and reasonable accountabiiity by verifying that speciflc public records have met current, approved minimum retentfon
periods before being destroyed pursuant to RCW 40.14.070.WAC 434-610.070,and WAC 434.640.010.-020, and-030. Please flil out this form when destroying public records
whose minimum retention is other than "Retaln untii no longer needed for agency business then destro�' (such as records covered in the "Records with Minimal Retention
Value"section of the Local Government Records Retentlon Schedule(CORE)).
Legal Dlsposition Authority(taken from Records Retention Schedule) Agenry Records
Description Date Method of
Records5erles Tltle Records Serles Records Retentton Minimum Reter►tlon Period (Box/Item numbers Dates('overed ��nimum Destructtun(See
DAN Schedule volume,etc) � R�nettlon �mples below•)
-Flna,�a,f � s2r���- (D �eA.�s c�fE,e.a'Z d:�' y �� amioLe,
�r+ar�u,c-t-�o-�s tB�t �ev �I�E d pf �rsc.ce.( �.yea.R -�'�a.r,s��tEa,lS �111�u� _'1 J 3l I fl`� 1/1 J 12 5���R
��-ts � Us�o-o� c� S � f����y � o�s��
q�YBeYYtP-r�tS 1 I 124�/3 ���i � ' QQR1C Sln2�-h2 ���� '^ ��Z �J�� " 1 61ti.f22o�GQ.t
COYYI L2.-f'I�•�v
�,on�vt'�C�tS '� CZS�D- �1-
� c�,�tS GL�{,e,f2 �O,C�1 i-�� ou-15tcf.,¢.
��� c��� �K S � a�� - «a� �1�I os ��..��
�� Rev 3 co Yn Q i.e-t i o�, sv�x�e��.c�
•Examples of inethads of deshvctlon:electronlc deletlon,!n-house OR outslde contractor shredding,secure rerycling,other(descrlbeJ
Statement: The public records listed above have met their minimum retention perivd(s), are not subject to ongoing or reasonably anticipated litfgotion or
public records requests,ore rtot needed for aud/t or other agency buslness,and shall be destroyed.
The individual responsible for inventorying the listed records must sign below prlor to the Record's Manager approval:
► � � /�, tnc� n n ,,,` �
Employee5(gnature,��d��,���lilil/17e.. Printed Name: ��r t� �- w�� Dlvision: ��'Y��S � �������
The Records Manager must sign the approval of this request prlor to the destruction of the Ilsted records:
Records ManagerSignature: � Pr(nted Name: V'`u'►��� �r�� DateApproved: ���J� /�
The person/peopte responsibfe for the destructfon of records must sign upon destruction of the Iisted records:
Employee Slgnature: Printed Name: Date Records Destroyed:
Vendor Buslness Name((f used): Phone:
Vendor5(gnature: Printed Name: Date Records Destroyed:
The retentlon and dlsposition uction for this Public Records Destructlon Log is`Retain for the life of the agency"pursuant to CORFserles G550-09-06.
Fortn Revlsed OS/06/201a
�.�. ,� -- �__._�___ .- ___ _ _ _.._.._
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that specfflc public records have met current, approved min(mum retention
periods before being destroyed pursuant to RCW 40.14.070,WAC 434610.070,and WAC 434.640.010,-020,and-030.Please fill out this form when destroying public records
whose minirnum retention (s other than "Retaln until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retentfon
Va(ue"section of the Local Government Records Retentfon Schedule(COREJ).
Legal Dlspositlon Authority(taken from Records Retention Schedule) Agency Records
Records Serie9 Recards Reterrtion Description �a� Method of
Mtnlmum
Records Serie9 Title DAN Schedule Minlmum Retetrtion Per�od (Box/Item�umbers, Detes Covered ����� Destruction(See
volume,etc) M� exemples 6elow*)
-NYYtiQ. � US 5�7_ 0 f� �� VSQ-d-� i�Ali Ov�sl
��
�iri-t1� s1�aR.fs oy �R,e,t�� �1'Z.E s�ti�-ern.ev�+ �C'.r�.i� ►,uo Ks;n,eR.}� �/ �Jo l — lal3l!t�r �I t f oCA c,o�-t,rac�oR
IeCW e SI'RS S���
-��Yn�e, ca.rclS/ if r��4-vS-ed �� Pax�'roll artStot..e.
U55p-o3E "
-+�mQ.s�ts oy tzev c7 �1�� �,-ti�.em.e S ve,re� . Wor�csv�.e,e.tS t/ � 1°l�l - 12J 3l 1`� �� ��� c.orrt�c-l-�
-}►m,,e.C9�-�'d�S 5S0-t�3E i� r�oi-v��ol �oe2 . �a-yt�ol l ov-t�st�
-�ti�n�c. c�.e,�-t-s o y ,Re� o r��E ,�„�m.e,r+S,�.►�. ���-�S t/ t/o� - �2.13 t 1 b� c J t 1� c�-�,,�,�.'�ot��R
"Fxamples of inethods of destruction:electron(c deletlon,in-house OR outside contra r shredding,secure recyd/r+g,other(descrlbeJ
� Statement: The public records listed above have met�heir minimum retention period(s), are not subject to ongoing or reasonably anticfpated litlgation or
publlc records requests,are not needed for audit or other agency buslness,and sha/l be destroyed.
The Individuai responsible for inventorying the listed records must sign below prior to the Record's Manager approval:
Employee Signature: ! �l/�/l.X- Printed Name:w��r�� w�� Division: 1'�'��'f � �'�����O�'
The Records Manager must sign t pproval of thls request pTior to the destruction of the listed records:
Records Manager Slgnature: Printed Plame: v���� `�'�r�� Date Approved: ✓� �'��` �
The person/people responsible for the destrvction of records must sign upon destructfon of the listed records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor Business Name(if used): Phone:
Vendor Slgnature: PNnted Name: Date Records Destroyed:
The retentlon ond dispositlon action for thls Publfc Records Destructton Log fs'Hetaln for the llfe of the agenc�'pursuant to CORE seNes G550-09-06.
Form Revised OS/06/2014
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compllance and reasonable accountability by verifying that spec(flc pubiic records have met current, approved minlmum retention
periods before befng destroyed pursuant to RCW 40.14.070,WAC 434-610.Q70, and WAC 434.640.010,-020, and-03o. Please fill out this form when destroying public records
whose minimum retention is other ihan �Retain until rto longer needed for agency business then destro�' (such as records covered in the "Records with Minimal Retention
Value"section of the Locol Government Records Retention Schedule(CORE)).
l.egal Disposition Authorfty(taken from Records Reterrtion Schedule) Agency Records
Description Date Method of
Remrds Serles Tikle Rewrds Serles Records Retentlon Minimum Retention Pefrod {Box/Item humbere, Dates Covered Minlmum Destructf�on(See
DAPI Schedule volume,ete) ReMet��� examples below•)
� ���,, pr�So - ga.�.� , ��c, � y2�^'�S ctft,�.� . yd �. � '
c1a55 a�c�� ' ' - \�1�� 1 1 o wrr�rac-to;,Q
��d 5 t 3C.-e1G '� c;u��v+R.e, c1 a ss c,�m P t.e,f r o+� w o�.t-cs�-e$+ � � �ed d.i�
�a.eattvn �SO- PQ.R1,cs, �R.e.c. � �S a.�-t.ei2 ���°�, o��S�cI.A
cIQS� a�N��d� �3c.-��i ���� i 1 Co U°�'+rac-t-o�
R�.c�rt2c[S e � Cui�vie2 G�SS o�m �-� l Dw vao�MGSYYPJZ�` � /� s1n-��edd.t
RQ� i oi.�. �f�s o- F'a,R�ts. �e�. � c�ea.r5 o.�t�e,y�. ��y oo� o�rs�d.�e,
c�Ss a.-tFenofurr �,�_�°1 _ a.�' �- 20Q � 1 /l� i 2 c�nt�r�ae-b2
re.ec.or�.dS ev � C�ut tu►'lk. �I.0.SS Cp�m lQ��o w wotsKs�+.¢�1- c�ed d.f n .
•Examples of inethods of destruction:electronic delet�on,ln-i►ouse OR ouiside contractorshredding,secure recyding,other(descrlbeJ
Statement: The public records Ilsted above hwe met thelr minfmum retentlon perfod(sJ, are not subject to ongoing�or reasonab/y anticipated litigation or
pub/!c records reguesrs,are nvt needed for audlt or otf►er ogency buslness,and sha/1 be destroyed.
The individual responsible for inventory[ng the listed records must slgn below prlor to the Record's Manager approvai:
Employee Signature:G�/�/3'Y� ��o) �� Printed Name: �.����Z.� ���'�- Division: P���'C� � �C(2��-}-��l'Z'
The Records Manager must sign t approval of this request.prior to the destruction of the listed records:
Records Manager Signature: Printed Name: ��'`""`�� C�C/r��� Date Approved: ��f�3'[d
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor Business Name(if used): Phone:
Vendor Sfgnature: Printed Name: Date Records Destroyed:
The retentlon and disposltion octlon for this Publ/c Records Destruction Log is�Retaln for the life of the agencyN pursuant to COREseries GS50-09-06.
Form Revised OS/06/2D14
City of Bremerton Pubiic Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that specific publlc records have met current, approved minlmum retention
periods before being destroyed pursuant to RCW 40.14.070,WAC 434610.070, and WAC 434.640.U10.-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 destro�' {such as records covered in the "Records with Minimal Retention
Value"section of the Local Government Records Retention Schedule(CORF)).
legal Dlspositlon Authority(taken from Records Retention Schedule) Agency Records
Records Serles Records RetenUon Descrlption M(ni um Method of
R�O����� DAN Sehedule ��nimum Relention Perlod (Box/Item numbers, Dates Covered Retention ���Dn(S�ae
volume,etc) Mat �mples below+)
�i�'10l.�1 �S 2S>l� - C9 ��-r'S 0.ft2.;2 �yP.�.� ��S i
��nsac�io�s `$� �e�2 ��E �enc�- o�' �sca.f �}�e�R �.t� s � �� �AUq �f 1� ly s�eddin
-F�n CU'1 c.!ot�. C�S 2O l 1- lp ��S a�-t�. �ou t �(ti avtst d1�.
.�.�-�-,Sac�t�onS 10'-1 �2v C��.� � �' .�;5cce.l �� �n��#Fa,i.S �f0� - (D/C� t/�/ �lo c�e-rt�ctc�-o�.
a;�d' r�.ece i �L.i n
f;n nr�c;�a..i _ �s 2 o t 1 to .�e.a.ri s �te,►� �o��y eci�� eits�d1�
-{�s ac-�con� `�4 �ev 2. C1�t�� � � -Hs cc�,t c.`.eQ,R s��ct,fS p?/pCl _ 12.f C7�j �f 1� t CD �cn+rcfctoFL.
ne c� dC(.�n
"Exvmp/es of inethods of destruct/on:e(ectronlc deletlon,ln-house OR ouislde contractor shredding,secure recyding,other(describeJ
� Statement: The pub/fc records llsted above have met their minimum retentlon perfod(sJ, are not subject to ongoing or reasonab/y anticipated litigation or
publlc records requests,are not needed for aud)t or other agency business,and shall be destroyed.
The individual responsible for inventorying the listed records must sign below prlor to the Record's Manager approval:
Employee Signature� . w�'�`�' Printed Name: ����� ��� Division: P���S � �G�`"Q�'� ��V�''
The Records Manager must sig e approval of this request paor to the destruction of the Ifsted records:
RecordsManager5lgnature: PrtntedName: ��`���"hV� �/�� DateApproved: �����/(O
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Name: Date Records Des�troyed:
� Vendor Business Name(if used): Phone:
i
Vendor 5lgnature: Prfnted Name: Date Records Destroyed:
The retentFon and disposition action for this Pub/ic Records Destructlon Log!s"Reta/n for the/ife of the agenc�pursuant to COREserfes GS50-09-06.
Fortn Revised OS/06/20]h
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that speciflc 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 destro�' (such as records covered in the "Records with Minimal Retention
Value"section of the Local Government Records Retention Schedule(COREJ).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Records Series Rerards lteterttion Descriptton ���m Meihod of
Reeords Serles Tltle DAN Schedule Minimum Reterrtion Perlod (Box/Item numbers, Dates Covered RetenUon ��uction(See
volume,etc) M� examples below')
�eGre,0.-tiow P'R9�-�3C.- F�ts, '(.v �"�2 r'O°� °"�`'`l outS►
��ass�,�� q +Reu o �e,c- � c��� uQ�rrpl.e.�iow �°''�`�.e t / 1 J 02 - 1�-131 t 02 �� �? �rnracto�
vpSac�S � u}oi¢KSV�1t¢. � �n
a-t�d�.�• PRSo-�3G �vcs,�.a.c. � .e�'S u�-t� �o� ' �
ass a�ler�aan ,�t tie� fl c�1-�v�te. `� �.�e.n dc�.nn �� � ( p t - �?�(31�01 �1 r t v'� ��a�o,�
�z e c�d S � cJl 0.5 S co rn �.-t�o u,�.ycsl��o�¢.-}s s b r.,v� d'c�,t r�
�a.s at��� �'R So-�3�C,- Pa.+-K�3, p.¢�. e9 `'�,2�rS °`�F'k�e.�2 ��°,,1nclaun�2 l r outS�oC.a,
tv�.vr-dS lq 'R+P�1 C3 '� C�A�IT�e c.IQSS CArn 1R.-t�O✓l, WG�CKS�LR.+2,{S �` ���O— l Z9��� ���I �, �51�L0^eC�C�.i
"Examples of inethods of destruction:eledronlc deletlon,in-house OR outside contractor shredding,secure recycling,other(descrlbeJ -
Statement: The public�ecords listed above have met their minimum retention period(s), are not subject to onqoing or reasonably anticipated litiqation or
public records requests, are not needed for audlt or other agency buslness,and sha/l be destroyed.
The individual responsible for inventorying the listed records must sign below prior to the Record's Manager approval:
Employee Sfgnature:(o w��JL/l7�-� Printed Name: ��.� �.�.� ���X. Divlsion: �Q�1'� ;� �-�-�'e�-�'l �LL.
The Records Manager must sig pproval of this equest prior to the destruction of the iisted records:
�
Records Manager Signature: rinted Name: ��vl Yl.f,lrt �- 1..��'!!� Date Approved: /��I� l`�
7he person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor Bus(ness Name(if usedj: Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention and disposltion actlon for[hfs Publlc Records Destructlon Log!s"Retafn for the llfe of the ogency"pursuant to CORE series GS50-09-06.
Form Revised 05/06/2014
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by ver'rfying that specific publlc 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 destro�' (such as records covered in the "Records with Minimal Retention
Value"sectlon of the Loca!Government Records Retention Schedule(CORFJ).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Records SeHes Records Retention Descrlptinn Minimum Method of
Records Serles Tttle DAN Schedule ��nimum Reterrtlon Period (Box/Item numbers, Dates Covered Retention Destrudion(See
volume,etc) Met �mples below')
���a.r�caCt,� , c�52.o�l- (� �ea�rs a.f-+r,e=,� daa�y cast,� �trFS�'ol�ar
.�rax�sc�c��o��s ���-t �2e.v 2 CA I�� � o� �is� �ea.� �rw,sv�n:�t+�.s C� t f �-� - l O�30)0� 1���1 t-( c�n-trac�t�on
�t no,.n c�a.ti C�S 2011 - (.o �.e.ax"S t�..F�X'� dc�;��y c.ctSL.. �V+Sidf,e.
-trra��scxc-t�o ��� '(�eV C.o IR� e,r�t uf �5ca.f -�v�r�,ns rna , S Z� t��"1 — �1 �3��0 111� 1�-( c,on-Fractora
�:na.��c�1 , fa S 4�6`"' (.0 �ea�S c�t 2i=' da:�iy �2s{�. outSld�
.�.nsa�-�« ,.�,, -��4 c.r�reL �+�►�.,-r�as a j �c�( �y - �t 1�t J �-I i/� / t I �n+���2
e,�.e,�a•� 2 e� �f' -�scc� �. ,R.�.�.�e�� dd�
*Examples of inethods of destruction:electronlc deletion,in-i►ouse OR outslde contractor shredding,secure recycling,other(descrlbe)
Statement: Tbe publfc records Ifsted above have met their minimum retention perlod(s), are not subject to ongoing or reasonably anticipated litigat/on or
publlc records requests,are not needed for audit or other agency buslness, and sha/l be destroyed.
The Individual responsible for inventorying the listed records must sign below prior to the Record's Manager approval:
EmployeeSlgnature:/—� ! / K.Vv�`�^"Printed Name: �� �R W�� Divis(on: f ��S � �Recv�.ea-t� ni.�,
The Records Manager must sign pprovat of this equest prlor to the destruction of the iisted records:
Records Manager Signatur • Printed Name: �� l�{�lJV� �r� Date Approved: �o` �� �J
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee S(gnature: Printed Name: Date Records Destroyed:
Vendor Business Name(tf used): Phone:
Vendor Signature: Prtnted Name: Date Records Destroyed:
The retentlon and dlsposltlon octlon for th/s Public Records Destruction Log is"Retain for the Ilfe of the ogency�"pursuant to CORE series GS50-09-06.
Form Revised OS/U6/2014
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 aut this form when destroying public records
whose minimum retention is other than "Retain until no longer needed for agency business then destro�' (such as records covered in the "Records with Minimal Retention
Value"section of the Loca!Government Records Retentlon Schedu/e(COREJ).
Legal Disposition Authority(taken from Records Retentton Schedule) Agency Records
Records Series Records Retention Descriptlon Minimum Method of
lierords Series Title DAN Schedule Mlnimum Reterrtlon Period (Box/Item numbers, Dates Covered Retention Destructlon(See
volume,ete) M� examples below•)
f�t�ciccQ,i GS?.nli - � �y �ea.r-s c�'-�e;� da�l casc,, outs�
-�scac-�tons � ��rr..i=K-a.(s 11 0/oc�- s13t j 4�(r� ����3 3 co�c+oR
� r 8 y r�2v 2 �� e,r�c� of fi S�.f y,e�oc.R �d rsecei ts sL�.��e d cU �
.��no►�r►ct Q„i y 5 2�1 t- (9�e�s o.�''t2ve ��y �S o�-ts t o�.z,
.�sQ��io ns t�,� �,e.v 2 ��� � �f' fis�+�i .�(2 �rr�s,rr,A+�a�s �1 J 1 l 0� - �-)l 15� i 11 �t S �,�nac-to�t
wi and t�.e ' c r?
�r-+c�n�a-� c�S 2�1 t- c� �c�cZrS c�ft�2 da+ty c c� I� ou-ts'�oC.¢
.��.n.cac-tc�or�s �$y yeev GOVQ� ¢�►d �F' f'�sc�rz.i ye:c�c.�e -t+rar►,swi.i-f�ts -�jl(o� 02 -,�)31 �D 11�1� �����
"Exomples of inethods of destructlon:electronlc deletion,in-house OR outside contractorshredding,secure recycling,other(descrl6e)
Statement: The pub/lc records listed above have met thefr mfnimum refentlon period(s), are not sub�'ect to ongoing or reasonab/y anticipated litlgatlon or
publlc records requests,are not needed for audit or other agency business,and sha/l be destroyed.
The lndfvidual responsible for Inventorying the listed records must sign below prior to the Record's Manager approval:
�'�� > > �X 1/V��-P w��Y� tx, w� lK. Dlviston:_ t �"' `� �l 1"�'`�'��'�`"k'� �V�•
Employee Signature: rinted Name:
The Rec�rds Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signature: Printed Name: �--G"�I��wl l..•L•'�r�l�- Date Approved: I � ����/�
The person/people responsible for the destruction of records must sign upon destructlon of the listed records:
Employee5ignature: Printed Name: Date Records Destroyed:
Vendor Bus(ness Name(If used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention and dlsposRfon action for thls Public Records Destructlon Log!s"Retain for the Ilfe of ihe agenc�"pursuant tn COREseries GSSQ-09-06.
Form Revlsed 05/06/2014
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that speciflc public records have met current, approved minimum retention
perlods before being destroyed pursuant to RCW 40.14.070,WAC 434610.070, and WAC 434.640.010.-020,and-030. Please fill out this form when destroying public records
whose minirnum retention is other than "Retain until no longer needed for agenty business then destro�' (such as records covered fn the "Records with Minimal Retention
Value"section of the Local Government Records Retention Schedule(CORE)).
Legal Disposition Authority(taken from Records Retentton Schedule) Agency Records
Oeserlption Date Method of
Records Series Records Retentlon M(nlmum
Records Series Title Minlmum Retention Period (Box/Item numbers, Dates Covered Destruction(See
DAPI Schedule volume,etc) Re��on �mples below•)
CJO{'l�a�� G55�-0�— Z.D LrQ.0.�('$ 0�:1� �.t l l�l.� � �U'tSl C�t+
acJ`e�xn�.�t+S� ti f�.v 3 CJ�12E �rn�l.e..-Eio�.... �Kst�e.t`t.e.v ��5 1 f l�tZ �ddin
���� �r��-��a�, �cs , rae� � �e,o�5 a�� �� aa��y owsol.e,
U�a�"` 1q �ev o � c.uJ►-tv�e c,1c�.Ss c.�cY.QUe.���v�- �aa,r,c� �f � ��y -� 2�31 j �y 111�l l con-w-cac+o�a
Fi r�a�ct t�,f wo s1�.�-e:�c�.�n
C-�5 2ot 1- � a��,e,� d,a:i c�Sl.. ovts t o�Qx.
�}rr�,rt s C�c��o�S t��-1 R�v 2 �r E � �+ro�.r►c m-rHc�.lS �i 1 t J�D� --12�3 t �d l j !���O x
enc� oF f,'scr�,1 �ye:a�t �,�rec.��Pt.s ����
"Examples of inethods of desrtrucHon:eledronfc deletlon,in-house OR outslde contractor shredding,secure recycling,other(descrlbe)
S[atement: The public records listed above have met their minlmum retentlon period(s), are not subjed to ongofng or reasonably anticipated lltigation or
publ/c records requests,are not needed jor aud/t or other agenry business,and sha/l be destroyed.
The individual responsible for inventoryfng the listed records must sign below prior to the Record's Manager approval:
Employee Signature:�,�(�}�/L.� ,w�Printed Name: ��'e-t�� ��� Division: �a'�� � �G��'{��w
The Records Manager must sig e approval of (s request�,prior to the destruction of the listed records:
� �
Records Manager 5lgnatu : Printed Name: ��� �n�Y��— Date Approved: /� /��`�
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Stgnature: Prtnted Name: Date Records Destroyed:
Vendor Business Name(if used): • Phone:
Vendor Sfgnature: Printed Name: Date Records Destroyed:
The retentlort and dlsposltlon octlon for thls Publlc Records Destrudion Log is"Retain fnr the life of the agenc}�pursuont to CORE serles G550-09-06.
Form Revised 05/06/2014
City of Bremerton Public Records Destruction Log
The purpose of this form is to document compliance and reasonable accountability by verifying that spectfic public recards have met current, approved minimum retention
pertods 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 "Retatn until no longer needed for agency business then destroy" (such as records covered in the "Records with Minimal Retentfon
Value"sectfon of the Loca!Government Records Retentlon Sci►edule(CORfJ).
Legal Disposttlon Authority(taken from Records Retentlon Schedule) Agency Records
Reeords SeHes Records Retentton Deserlptfon Mlnimum Method of
Rewrds 5erlas Tkle Minimum Retertdon Period (Box/Ftem numbers, Dates Covered Destructt'on(510e
DAN Sehedule volume,etc) R M�°� exempies below•)
f�n�� C�S '�l\_ ta �s a��t�,¢e.ra� �U-j csxsl... �vts�otst.
-�rar�So.c�co nS CO�C oF' fisca.f �C�2 �'►''�+'�Srru ital �'l � D�-1 - 12.�3l �(�j 1!1 f l� c,or��racto�e
��-4 �e� 2 d- �a¢..c.er' sirua,edd.i '
nCtX1G1 Q�I C-�S 2�11- lp �.�-P.�S �'-F.e-�2 dc�i.�t CA,TI.� niJ'tS�cl.Jt.
+��n S(�c�o ns�� �2 C�7�2� c�f -Pisca.( c�e.a,�t �`�`'� 1��� 1�t��3 co+-�-4��-�or�
�na.nc:�cU C�S ?�011- � c�2l�S c�tRXi o�a:i i y c.a.si� 0�5�ol.e.
-+rralns�-��onj t�y 1� 2 �'(�E e� oF{�-c S�� �.R -kra.�m'�Ha.lS � l�1�� 1�11�'-� r.o n-tr��-�o�R
a.l ar�d IR�ei s d c J 2�n
�Examples of inethods of destrud/on:electronlc deletlon,in-house OR outside contractor shredding,secure recycling,other(describe)
Statement: The publlc records listed above have met their minimum retentlon period(sJ, are not subject to ongo/ng or reasonably antfc/pated litlgatfon or
publPc records requests,are not needed for audit or other agency buslness,and shall be destroyed.
The indivldual responsible for inventorying the listed records must sign below prior to the Record's Manager approval:
Employee Signature:,,(��{/�'1 0 ��1�17� Printed Name; �i'Q.�{�LQ. ��LG Divlsion: �� � '�'�-Y'�e�����'
The Records Manager must sign the approv i of this request prior to the destructlon of the Ilsted records:
Records Manager 5ignature:�--_ Printed Name: `� ✓L�� �r��' Date Approved: �� "� /�
The person/people responsible for the destruction of records must sign upon destructfon of the listed records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor Business Name(if used): Phone:
Vendor Signature: PHnted Name: Date Records Destroyed:
The reteniFon and disposltlon acUon for this Publlc Records Destruction Log!s'�ietain for the Iffe of the agenc�pursuant to COREserfes GS50-09-06.
Form Revised OS/06/2014
City of Bremerton Public Records Destruction !og
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 thls form when destroying public records
whose minimum retention is other than "Retain until no longer needed for agency business then destro�' (such as records covered in the "Records with Minimal Retention
Value"section of the Local Government Records Retention Schedule(COREJ).
legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Remrds Series Records Retentton Descrtptlon Mtnl um Method of
Recorcls Series Tkle DAN Schedule Minimum Retention Period (Box/Item numbers, Dates Covered Retention Destruction(See
volume,etc) M� examples 6elow')
Ft nc�,nc.t u.I �S2�p�1- C� o�.rS a-�F{� a!'.au�y casl� o+�ts+c�C..z
-�v�a.ns ac-ti ons ��y +Rev 2 �IRE �;-�,�of'{�'sc�.f �,e� �vsev�crzttf�'U q f ilol�1 - 1 Z�31�o t l�� �a� s�da,�'r�
-Ftna.vl c:i c�.+ _ Cz S 2�0 t t- (o �ea.rS a�'+-e.t2 d��y casl.. o�ts icF_e
-{raa'�Sac�ns 14�y Y�v 2 C.�14� �C o f'f'iscct,l y-eaR ��'is�a $�t ��S - �2��t!O S 1,d��2 ce�t�to�
-Fi nac�c.(a,l C�S 20l 1- la �es�x'S a�.Q.r2 �oul c.a.s1.• ovtS�c�.
-�ra.r�s�i'O ��LI rzev 2, CAI�'E e+�C csF -f-isct�.! ��2"����� � � ���2 - �-1� l5�� 1 �r/0� c�onfv�a,c.�o�
a.r� r�c��D�}S
*Examp/es of inethods of destructlon:electronic de/etion,in-i►ouse OR outslde contractorshredding,secure recycling,other(descrlbeJ
Statement: The public records listed above have met their minimum retentlon period(s), are not subject to ongoing or reasonably anticipated litigatlon or
publlc records requests,are not needed for audit or other agency business, and sha/l be destroyed.
The indlvidual responsible for inventorying the listed records must sign below prior to the Record's Manager approval:
Employee 5(gnature''�, ��wv� Printed Name:��I��. �wl� Divislon: ���-.] 3 ��ea-tr or.�,
The Records Manager must stg pproval of 's request prior to the destruction of t listed records:
Records Manager 5ignature: Printed Name: / �� �r�� Date Approved: /����/�
The person/people responsible for the destruction of records must sign upon destruction of the Itsted records:
Employee Signature: Printed Name: Date Records Destroyed:
Vendor Business Name(if used): Phone:
Vendor Signature: Printed Name: Date Records Destroyed:
The retention and disposition action for this Pub11c Records Destruction Log is"Retain for the life of the agenc�'pursuont to CORE seNes GS50-09-06.
Form Revlsed 05/06/2014
City of Bremerton Pubiic Records Destruction �og
The purpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum retention
pertods before being destroyed pursuant to RCW 40.14.070.WAC 434-610.070,and WAC 434.640.010.-020,and-030. Please fll�out this form when destroying public records
whose minimum retention is other ihan "Retain urttil no longer needed for agency business then destro�' (such as records covered in tfie "Records with Minimal Retention
Value"sedlon of the Loral Government Records Retention Schedule(CORE)).
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c�,l' t9�-1: ,t�v'L ¢v� c� -C�iS4� � ,Pe.�r'�Urs�. s) S�uQ¢.dof.i
Tiwcx.ca�r S�„ .�,S�o=o3. � - . . . .. , h�+,v� ,2�►� Re���e pa-y��1 otrts�cC,e.
` �-�tvrisi:`s�rvZli-Et.. `.25 :Y.�1 ' CJO�ZE U�,a.i��cat��o�:..:i,� - woreKsl�¢, l/1 �l� —�L13 i J 1 I 1� � 1�lo cs.o'�-t d�+2
�� sv�o. , t. . :• : , �S;50=0 3 . .-' . viofi �-rotie :V?2ttir�2� (�y�11 �u-�si cl.�e.
c�c,v,,rn�. �,� . - . _ > c,o.YZ�� . . � '� �ecw � r �o—�2l 3�j��� ��1 !d c.o �o,r,-tra��o�
. . , .. -
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sExamples of inethods of destructbn:e%ctmn/c deletlon,in-house OR outslde contracYor shredd/ng,secvre recyding,other(descrlbe)
Statement: Tlre publlc reconds llsted abave have mei their minimum retenNon perlod(s), are not subjed to ongoing or reasonably arrtidpated Ntigatlon or
public recorafs repuests,are not needed for audit or other agency buainess,and shall be destroyed.
The fndividual responsible for inventarying the tisted remrds must sign below prior to the Record's Manager approval:
Employee Signature:� �� Prtnted Name: ��� h��- w�� Dlvlsion: PQ•r`Z�Q � 1�'�G�Qf!n�L'
The Records Manager must slgn the approval of thfs request prfor to the destruction of the listed records:
Records Manager Signature: • Printed Name:�(�' 'ls�n�n�n ���`? � Date Approved: /� �" /�"
The personJpeople responsible for the destruction af records must sign upon destruction of the Ilsted records:
Employee Signature: Printed Name: Date Records pestroyed:
Vendor Business Name(if used): Phone:
Vendor Signature; Printed Name: Date Records Destroyed:
The reteMfon and disposJdan odlon for this PubHc Rernrds Destructlon Lvg is"Retoin for the life of the agency"pursuant W CORE series GS50-09-06.
Form Revised OS/O6/2014