HomeMy WebLinkAboutPARKS & RECREATION 10/13/2020 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 Title Records Series Records Retention Minimum
Minimum Retention Period (Box/Item numbers, Dates Covered Destruction(See
DAN Schedule volume,etc) ion Met
examples below*)
v S•ill • ac,b1 reAckAi-t--Ft)i y y.2aq (U7-fW c Si 0U,
d s:c,i Ca52�1Z— C,0.12 E.
()Stu�►2e end of a-g reem.¢r*c 2ao3 i I ti a st, it c d(h
il• Scents) 045 •0 s ton k• 1 .F~Sccu yR-ktAszn ci¢S-W- aq vatsi,c.swEsg, ccon-vraC-t0?.._
F cal GS 20\1- C,(�,,E, PeiIu.+w-FO lk In aT s`� r2 o vt Si�l h
by sac-tc�n5 o e,� evvot o4 - cal i IMF H-aCt at°k(v - \10\9> i 01/ s o,
-off'I uLK.a.1 'g��V } v{'KlUci Li-1 (I-eac+ i ofiS-fIr bar1 kAA-LRt FS Con-klrciC4o -
FAna.nc ia1 CAS 2011- Co E Re-1W k, fog- to ;y C4S ov-FS�CIR,
4Vcf S aC-k k anS �1 -k RSIN.?, ve,V i o y. I0.f{e l+� a f ff S cal Wo-x1s Mil+lcilS I con o�3 1 c) `� 11111.0 ,I skAQ e d c
criA ,R.a.lc .-fir A ckfii-frok i SYZ YZ co,rWac-i-oo-
*Examples of methods of destructi25n:electronic deletion,in-housdOR 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 the listed records must sign below prioror to the Record's Manager approval: [� p n/� ,, ,� 1
Employee Signature: �ted Name: Q�"�11'LYU �A�JZ. Division: t QIY'Z-KS 3 1�'�-�1'�-K_S -T( ®c
The Records Manager must sign th approv.l • •is is request prior to the destruction of th
e
listed records: 0.__ 411L�"� .0 P ' e: Date A roved: " 0113l2Records Manager Signature. ranted Nampp
The person/people responsible for the destruction of records must sign upon destruction
�tof�the
plisted records: ,, I
Employee Signature:_te inted Name: W1Q I y t. Ad w�ZX. Date Records Destroyed: ( 0 I)3 1 2,010
Vendor Business Name(if used): bL rn Ct9, 'r1 0 6 I L L- S171 2 c1 c1 l n J�i Phone: 1 - 8„- ?3,01 - 0 t l .2
Vendor Signature: S Q,Q C.' .x he k 0r Printed Name: Date Records Destroy`etf'-----_..01 k3 I ?-
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
Or, &fdeK- 6
�` Local Government 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 all 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 Common Records Retention Schedule (CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Date Method(s)of
Description
Records Series Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule Retention (See examples,
volume,etc.) Met below*)
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 1 11/18/03-11/6/2005 1/1/2011 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
Recreation class PR50-13c- Pars, Rec. Retain until no longer needed Sr. center box 1 9/10/1993- 12/2004 12/2005 Outside contractor
attend. records 19 Culture 1.0 for agency business & Shredding
completion of St. Auditor
report then destroy
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 1 1/2011-12/2011 1/1/2017 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
*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 or invent ing the listed records must sign below prior to the Records Manager's approval:
Employee Signatur : (etj C.L.L:� Printed Name: L1S/1/ c-e-i/‘`^-0 Division: ` .cd kVe . c c CAI`
The Records Manager must sign the,ap roval,7 ,this request prior to the destruction of the listed records:
Records Manager Signature: \ Printed Name: ,1 el-ail06 Date Approved:
`7/. /2-
V
The person/people responsible for the destruction` of;recoorrds must sign upon destruction
�of�the listed records:
Employee Signature: Z..1 O C \/ LQ
rinted Name: '.� 1 ley \k) Date Records Destroyed: 101 \3 I 2-0
Vendor Business Name(if used): M ci ;*fit > dckk n9 Phone: ( — 1. C-6C1 — 011
Vendor Signature: ,Q -k ,_CCi Printed Name: _'----Date Records Destroyed: %of 1 / a-_
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.
Local Government 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 all 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 Common Records Retention Schedule(CORE).
Legal Disposition:Authority(taken from Records Retention Schedule) Agency Records
Date Method(s)of
Description
Records Series' * Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule ' Retention (See examples,
volume,etc.) Met below*)
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 2 1/2006-12/2006 1/1/2012 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
*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'nventory' the listed records must sign below prior to the ecords anager's approval:' /
Employee Signature: tt Printed Name: Y1 54 661-f-
1 Division: C r, mil'r a/43,
� 'l.�
The Records Manager must sign th ii ppr •fnthis request prior to the destruction of the listed records:
Records Manager Signature: t �' Printed Name: "T r A1J(; Date Approved: i2'3)ZU
The person/people responsible for
�the
�destruction of�reco�r{d�s must sign upon destruction of the listed records:
Employee Signature: e tI V r r t A2UU\1`N� 4i44nted Name: R1 Date Records Destroyed: )0/ 13 /22cj
Vendor Business Name(if used): t , , 1 ay mO\O;1_2. S'V_ .Qi- ck.\Yl 3 Phone: 1 -' 1'1 -��'jc1l B - ° l t 7
Vendor Signature: b C�r"�� C� Printed Name: '�s�� Date Records Destroyed: \o I ,3 I -
0-e S1/VC-�AdN
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.
Local Government 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 all 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 Common Records Retention Schedule(CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Date Method(s)of
Description
Records Series Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule volume,etc.) Retention (See examples,
Met below*)
Financial GS2011-184CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 3 1/2007-12/2007 1/1/2013 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
Recreation class PR50-13c- Parks, rec. Retain until no longer needed Sr. center box 3 1997-2006 12/2007- Outside contractor
records, 19 Culture 1. for agency business & c shredding
emergency completion of St. Auditor
information report and then destroy
*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 fpr invent() ing the listed records must sign below prior to the Recor s Manager's approval:
12j
/ / 4 ✓ Division: �CL/6�IL.:,
Employee Signature: C Printed Name: /15/ 6atie7--
The Records Manager must sign the, pproval of this request prior to the destruction of the listed records:
20
Records Manager Signature: (. ' Printed Name: Vrr et-L---NiAt6 Date Approved: 1i 3J
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
\ d 1
Employee Signature: inted Name: ��"I t Lx Date Records Destroyed: \O 113) 2-02)
Vendor Business Name(if used): U..rnQ- C(`(1 O\ \k-Q- %•\AU-Q-�dk n3 Phone: \-CCI1 - C1 v 0‘ , 2"
Vendor Signature: S-12--Q- CR...r-k 1-1 _ Printed Name: Date Records Destroyed: \O f P -D-0
of AQ. -WOC tlD C`-,
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.
C4rceov
Local Government 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 all 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 Common Records Retention Schedule(CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Date Method(s)of
Records Series Records Series Records Retention Description Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule Retention (See examples,
volume,etc.)
Met below*)
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 4 1/2009-12/2009 1/1/2014 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
*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 f r invent f i g the listed records must sign below prior to the Records� Manager's approval: �i� n Employee Signatur : Printed Name: LS9 6a-/Ein-�'( Division: ���1�-cSr C) l etz/-‘
The Records Manager must sign the a iprov 1pf this request prior to the destruction of the listed records:
Records Manager Signature: &.4( � �.._kz Printed Name: `'`' {DO Date Approved: C1//
Z3/ZU
The person/people responsible fort the� destruction must sign upon destruction of the listed records:
Employee Signature: A�U ! ��..WUL.LU - Printed Name: C_ )R.kV1 ,(- -- \}JL._t5 Date Records Destroyed: lo/t3 ) ZJz�`ZU
Vendor Business Name(if used): Le' 0,-y fl' O‘"c:)i L. S\rU R 3dW1 J Phone: - Sct Y C3'l l 2
Vendor Signature: Sr-QQ_ U.A."441 CO Printed Name: \ f— Date Records Destroyed: \O( «) 2-020
of. CIQ..S--sc,W C.`k V.(5-c'
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.
,Yr6-0,k5
Local Government 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 all 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 Common Records Retention Schedule(CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method(s)of
Records Series Records Series Records Retention Minimum Destruction
Title DAN Schedule Minimum Retention Period (Box/item numbers, Dates Covered Retention (See examples,
volume,etc.)
Met below*)
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 5 1/2010-12/2010 1/1/2016 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
*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 r inven •Jong the listed records must sign below S prior to the Records( anager's approval:
Employee Signatur .1- i /.vt1 Printed Name: SH ,/rF-.^ , Division: Pafk5 gill (Yr'
1
The Records Manager must sign the a` prova!of this1f request prior to the destruction of the listed� records: r�j
Records Manager Signature: �IllYO Printed Name: �` U-ev�rG�� Date Approved: -1( a /4.;
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: . 'il.A ► V LX_.-WWLid- Printed Name: Date Records Destroyed: ) 2.0 2,0
Vendor Business Name(if used): �ma m)b\tiz., c> QC\dk Y1C Phone: t -`?)-11 `9 1 '0 , i)--
Vendor Signature: C QV- \-f•-iC OAS, Printed Name: ---- / Date Records Destroyed: 10 C 1 J 2 0 }
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.
C)2Akr ein(
Local Government 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 all 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 Common Records Retention Schedule (CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method(s)of
Records Series Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule Retention (See examples,
volume,etc.) Met below*)
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 6 1/2012-12/2013 12/31/201 Outside contractor
transactions rev. 3 fiscal year, destroy 8 shredding
Recreation Class PR50-13c- Parks, Rec Retain until no longer needed Sr center box 6 1/2011-12/2011 12/2012 Outside shredding
Attend. Records 19 Culture 1.0 for agency business & contractor
completion of St. auditor
Report then destroy
*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 r inve ing the Ii ed records must sign below prior to the/ Records Manager's approval: Nr-
TheEmployee Signatur Printed Name: L - �C ` Division: 2-(k5�Records Manager must sign the 'ppr•v- this request prior to the destruction of the listed records:
Records Manager Signature: / ` '11,0 J'P Printed Name: Jam.. � /2 X Date Approved: '
The person/people responsible for the destruction of records must sign upon destruction of the listed records: 1
Employee Signature `f11 Printed Name: c}e,( 1. Date Records Destroyed: l 0,1'3/ 2Ci
Vendor Business Name(if used): _c..�rT'C.\ O"11-�- s V_Qcd`n� Phone: (`(6-11—b�t� "O l k
� C�Y* Z
Vendor Signature: S-Q , V i CCX— — Printed Name: �--- Date Records Destroyed: f 0( (3/2-0 20
oc -kvt) C- l ( -
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.
c . C417 y
Local Government 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 all 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 Common Records Retention Schedule(CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Date Method(s)of
Description
Records Series Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule Retention (See examples,
volume,etc.) Met below*)
Contract/AgreemeGS50-01-11 CORE 4y Retain for 6 years after Sr center box 7 2000-2010 2016 Outside shredding
nts (MOUs) Rev. 4 termin./expiration of contractor
active us ads and agreement. Destroy
rentals
Recreation Class PR50-13c- Parks, Rec Retain until no longer needed Sr center box 7 1/2007- 12/2011 12/2012 Outside shredding
Attend. Records 19 Culture 1.0 for agency business & contractor
fitness completion of St. auditor
Report then destroy
*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 the listed records must sign below prior to the RecordsiManager's approval:
Employee Signature. �" C -� '} Printed Name: Division: rC�,
The Records Manager must sign the a prw f this request prior to the destruction of the listed records:
Records Manager Signature: OLLPrinted Name: -( 0-eviefia Date Approved: q (Z /2o
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
`p(Employee Signature: 1A� 0L Printed Name: cve �) A Q Date Records Destroyed: 1011,311020
Vendor Business Name used): a) .4"00 e)k SV k,/' �&1Y-10 Phone: PCY1 l' . ") - 0 k
�. �'I� \ CC\
Vendor Signature: �.�- � Printed Name: _ Date Records Destroyed: l 0� \3 ) 202_
Of W�-k to
S .. Gkr 60 5,. ql
ioFA
Local Government Public Records Destruction Log
rpose of this form is to document compliance and reasonable accountability by verifying that specific public records have met current, approved minimum
_iition 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 all 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 Common Records Retention Schedule (CORE).
Legal Disposition Authority (taken from Records Retention Schedule) Agency Records
Description Date Method(s)of
Records Series Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule Retention (See examples,
volume,etc.) Met below*)
Financial GS2011-184CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 9 1/2008-2/2008 12/31/2014 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 9 11/2007-12/2007 12/31/2013 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
Recreation Class PR50-13c- Parks, Rec Retain until no longer needed Sr center box 9 1/2005- 12/2011 12/2017 Outside shredding
Attend. Records 19 Culture 1.0 for agency business & contractor
fitness completion of St. auditor
Report then destroy
*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 inve t'lrying the list d records must sign below prior to the Records Manager's approval:
���, 1��� asks Ste. e .`
Employee Signature:Lw J Printed Name: S� �GLI� Division: /
The Records Manager must sign the`a.�prov of this request prior to the destruction of the listed records:
Records Manager Signature: i, �`ti Printed Name: Av
�Jt% irZO Date Approved:
V,
The person/people responsible for
rrlthe destruction of records must sign upon destruction of thelisted records:
Employee Signature Jj(J I'L,LV� �L Printed Name: CO1�) V �, 1U Date Records Destroyed: t O (3 ) .
Vendor Business Name(if used): t-k.,nna-y `r'no0\--(2- S v - 1"eCAd n9( Phone: 1-1611 -'(?)cl 8 —°k \-2--'
.Q.- C'Vendor Signature: ¶ QA--*\- i ca-L - Printed Name: � Date Records Destroyed: ( O/ 13 ) 2-C .20
ctVU`A.t 0 lti
Ser
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.
This sample form was prepared by Washington State Archives as a courtesy to local government agencies in January, 2014.
It may be modified to meet individual agency needs. p
Local Government 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 all 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 Common Records Retention Schedule (CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method(s)of
Records Series Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule Retention (See examples,
volume,etc.)
Met below*)
Recreation Class PR50-13c- Parks, Rec Retain until no longer needed for Sr center box 9 1/2007- 12/2007 12/2013 Outside shredding
Attend. Records 19 Culture 1.0 agency business&completion of contractor
fitness St. auditor Report then destroy
Recreation Class PR50-13c- Parks, Rec Retain until no longer needed for Sr center box 9 1/2003- 12/2003 12/2009 Outside shredding
Attend. Records 19 Culture 1.0 agency business&completion of contractor
fitness St. auditor Report then destroy
Recreation Class PR50-13c- Parks, Rec Retain until no longer needed for Sr center box 9 1/2003- 12/2003 12/2009 Outside shredding
Attend. Records 19 Culture 1.0 agency business&completion of contractor
fitness St.auditor Report then destroy
*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 the listed records must sign below prior to the Records Manager's approval:
Employee Signature: r, \�t (i( .� Printed Name: Division:
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signature: 12C1 Printed Name: Date Approved:
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: rt - P CIS e -F- 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 Public Records Destruction Log is "Retain for the life of the agency"pursuant to CORE series GS50-09-06.
60x
Local Government Public Records Destruction Log t 0
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 all 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 Common Records Retention Schedule (CORE).
Legal Disposition Authority(taken from Records Retention Schedule) Agency Records
Description Date Method(s)of
Records Series Records Series Records Retention Minimum Destruction
Minimum Retention Period (Box/item numbers, Dates Covered
Title DAN Schedule volume,etc) Retention (See examples,
Met below*)
Financial GS2011-184 CORE 4.y Retain for 6 yrs. after end of Sr. Ctr box 10 5/2008-12/2008 12/31/2014 Outside contractor
transactions rev. 3 fiscal year, destroy shredding
*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 or invent''rying the listed records must sign below prior to theRecords Manager's approval:� �,�
Employee Signatur : J Printed Name: L5-4
/c"" v�`/Division: ' S5; ��E (7—
The Records Manager must sign the approval of this request
prior to the destruction of the listed records:
Records ManagerSignature: t �' 6' .,W,��'v� Printed Name: C ' _ Date Approved: lC)/l ) 2
The person/people responsible r the dstruction of records must sign upon d struction of the listed records:
Employee Signature: QtfALO Printed Name: Cfr a;VAIDL) Date Records Destroyed: /23/262&
Vendor Business Name(if used): I Q. m C`V 1n 010 t2 5WP.Q C t '09 Phone: —(6-1-1' C -D IZ
Vendor Signature: C' .`LQ 7 ed Name: Date Records Destroyed: 1 D)13(Z0 J
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.
This sample form was prepared by W&shington State Archives as a courtesy to local government agencies in January, 2014.
Name: CO OP BREMERTON PARKS CERTIFICATE OF DESTRUCTION
Address: 680 LEBO BLVD { !ia iii Moyne -9v
City: BREMERTC 98310
Phone: 360-473-5305 //I p % 1 A'' o
'` j/'%!ter i�� �i i
Request: CORRINE-MR-DC �r f jrj ,CERTIIED `
r/1//0�//Gruel////40/3./mil%/l //J/Wf//lf//l/.V;7 )/
Account : 2185-952778-926 Service Date: 10/13/2020 Route Id: SN92 Ticket#: 1475995
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
CUSTOMER COPY
Service Description Qty Rate Amount
SHEXB 1.00 SHRED EXTRA BOX 3.57
SHPURGE 1.00 SHRED ONE TIME PURGE / 35.70
Driver Signature: Gg/ Date: Truck
Customer Signature: Date: Time
2910 Hogum Bay Rd Olympia Wa 98516 E-Mail: Ims@wcnx.org Phone: 1-877-898-0112 Fax: 1-360-486-2467