HomeMy WebLinkAboutPWU 121123City 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) Agi
Description
Records Series Title Records Series Records Retention Minimum Retention Period (Box/Item Dates Covered
DAN Schedule I numbers, volume,
Billing Stubs GS2012-046 Local Government Retain for 4 years after 8 Boxes — 2017 and 2018
Rev. 0 Common Records end of fiscal year or until Payment stubs.
Retention completion of State
Schedule (CORE) Auditor's examination
Version 4.2 report, whichever is
(August 2021) 1 sooner then Destroy.
Records
Date Minimum I Method of
Retention Met Destruction (See
examples below*)
1/1/2023
*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 fisted r rds must sign below Aprrior to the Recor 's Manager approval:
r...,....i........ c:..�......... �//::�/ �� y .. ��A n.:...,.a n�.,.,,.... W A -JAY-1-/ /d'I !, L r Cam/(/ n:.,:..:..... /2.11 /y-3
The Records Manager must sign the approval of this reques prior to the destruction of the listed records:
Records Manager Signature:6Aat-t Printed Name:, H I I I�A I� I 1� Date Approved: I f ZC%�
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: c n ! { Printed Name: Date Records Destroyed:
11'�� 4 �A� YI Vendor Business Name (if used): V� L 4 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.
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 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)
Records Series Title
Records Series
Records Retention
Minimum Retention Period
DAN
Schedule
Financial
GS2011-184
Local Government
Retain for 6 years after
Transactions -
Rev. 3
Common Records
end of fiscal year then
General
Retention
Destroy.
Schedule (CORE)
Version 4.2
(August 2021)
Agency Records
Description
Date Minimum
(Box/Item numbers, Dates Covered
vRetention Met
volume, etc.)
65 Boxes - 1987, 1988, 1989, 1990, 1991, 1/1/24
Receipts, billing 1992, 1993, 1994, 1995, 1996,
statemews, billing 1997, 1998, 1999, 2000, 2001,
summaries, 2002, 2003, 2004, 2005, 2006,
adjustments, 2007, 2008, 2009, 2010, 2011,
journals, purchase
2012, 2013, 2015, 2016, 2017
orders
*Examples of methods of destruction: electronic deletion, in-house OR outside contractor shredding, secure recycling, other (describe)
Method of
Destruction (See
examples below*
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 Record's Manager approval:
Employee Signature: Printed Name: Division:
The Records Manager must sign the approval of th's request prior to the destruction of the listed records:
Records Manager Signature: Printed Name: H I Icti, l I(dl I )i 1 -, n Date Approved:I dZ
�
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):
52 c"I
iIAC
YI CCU . _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.
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 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)
Description
Agency Record
s
Method of
Records Series Title
Records
Records Series
Records Retention
Retention Period
(Box/item
Dates Covered
Date Minimum
Destruction (See
DAN
Schedule
numbers, volume
Retention Met
examples below*)
Local Government
Retain for 4 years after
etc)
7 Boxes —
1/1/2016
Leave/Overtime -
GS50-04B-09
1987, 1996, 2000, 2006, 2007,
Routine
Rev. 2
Common Records
end of fiscal year or until
Leave/Overtime
2008, 2009, 2010, 2011
Retention
completion of State
sheets.
Schedule (CORE)
Auditor's examination
Version 4.2
report, whichever is
(August 2021)
1 sooner then Destroy. 11
*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 li,.zed re r s must sign below prior to the Record's Manager approval:
Employee Signature: Printed Name: ,-V 'i %! � Grfl Division: 12 h 3
The Records Manager must sign the a proval of this request rior to the destruction of the listed records: !
Records Manager Signature: �'2' Printed Name: 1� cJi I Date Approved: I t 3
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): kc J , 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.
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 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)
Records Series Title Records Series Records Retention Minimum Retention Period
DAN Schedule
Employee Pay - GS50-03E-15 Local Government Retain for 4 years after
History Rev. 1 Common Records end of fiscal year and no
Retention longer needed for agency
Schedule (CORE) business (including
Version4.2 retirement benefit
(August 2021) verification) then Destroy
Agency Records
Description Method of
(Box/item Dates Covered Date Minimum Destruction (See
numbers, volume, Retention Met
examples below*)
etc.)
7 Boxes -Time 1989, 1999, 2001, 2002, 2003, 1/1/2023
Sheets 2005, 2006, 2007, 2008, 2009,
2018
*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 inventoryin the liste cords must sign below prior to the Record's Manager approval:
Employee Signature: Printed Name:L4V/ / �� Division: ( 1
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
&I'
Records Manager Signature: Printed Name: H I I I A o,4 H(A � 114on Date Approved: f I C_J
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: `- Printed Name:
Vendor Business Name (if used): ��c >A��( k CJ . _ Phone:
Vendor Signature:
Printed Name:
Date Records Destroyed:
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
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
Method of
Description
Records Series Title
Records Series
Records Retention
Minimum Retention Period
(Box/Item
Dates Covered Date Minimum
Destruction (See
DAN
Schedule
numbers, volume
Retention Met
examples below*)
Utility Services
Retain for 1 year after
etc.)
2 Boxes —
2009, 2015 1/1/2017
Line Location
UT50-32-05
Requests
Rev. 1
Records Retention
request fulfilled then
Records relating
Schedule Version
Destroy.
to line location
1.5 (June 2021)
requests.
*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 lis d records must sign below prior to the Record's Manager approval: ` ✓�
Employee Signature: Printed Name: W c Division:
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signature: &UVA71 Printed Name: ��) 1 N ; ZI f I n co, I n _ Date Approved:
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signatu
Printed Na
Vendor Business Name (if used): l C + (ALam! Phone:
Date Records Destroyed:
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.
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 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 otherthan "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 (Box/Item Date Minimum Method of
Records Series
Records Retention
Records Series Title
DAN
Schedule
Minimum Retention Period
numbers, volume, Dates Covered Retention Met Destruction (See
etc.) examples below*)
Backflow
UT55-06A-01
Utility Services
Retain for 5 years or life
8 Boxes — Backflow
2003, '2004, 2005, 2006, 2007,
1/1/2022
Preventer
Rev. 0
Records Retention
of backflow preventer,
Inspection/Inventory
1 2008, 2009, 2010, 2011, 2012,
Inspection and
Schedule Version
whichever is shorter
2013, 2014, 2015, 2016
Inventory
1.5 (June 2021)
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 a listed records must sign below prior to the Record's Manager approval:
Employee Signature: w Printed Name:_z Ar Yo�/� Division: `Z— j/ 2
The Records Manager must sign the approval of this request nor to the destruction off the
e listed records: �`
Records Manager Signature: � � � Printed Name:
11) (�� �\4 H (,{rni �' 6n Date Approved: 2-1 ) I ZS
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: pp (� L Printed Name: Date Records Destroyed:
Vendor Business Name (if used): SL L 1-1�1 JGC►'I— CJ • 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.
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 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 otherthan "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 Method of
(Box/item numbers,Dates Covered Date Minimum Destruction (see
Records Series Title
Records Series
Records Retention
Minimum Retention Period
DAN
Schedule
volume, etc.) Retention Met examples below")
Contracts and
GS2011-169
Local Government
Retain for 6 years after
1 Box —
1996, 2000, 2001, 2002
1/1/2009
Agreements—
Rev.2
Common Records
completion oftransaction
Grants/Loans/Bond
Capital Assets
Retention
or 6 years after
(Non -Real
Schedule (CORE)
termination/expiration of
Property)
Version 4.2
instrument or 6 years
(August 2021)
after disposition of asset
(if asset owned by
agency), whichever is later
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 listecj-rign below prior to the Record's Manager approval:
Employee Signature:TV4-,:�Zd Name: f [ G�(J A�/ e- / �'� Division: 2A'/
The Records Manager must sign the approval of ths request prior to the destruction of the listed records:: I �
Records Manager Signature: j`i Printed Name: I �1, I b I l `L� Date Approved: Z I 1
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: �] l Printed Name: Date Records Destroyed:
Vendor Business Name (if used): �tc i" 1 `:�[.AC k i � • 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.
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 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)
Records Series Title i Records Series Records Retention Minimum Retention Period
DAN Schedule
Maintenance —
GS2012-040
Local Government
, Retain for 3 years after
Minor Non-
Rev. 0
Common Records
end of fiscal year then
Regulated
Retention
Destroy.
Schedule (CORE)
Version 4.2
Agency Records
Description
(Box/Item Dates Covered Date Minimum
numbers, volume, Retention Met
etc.)
3 Boxes — Work 1999, 2000, 2001, 2003, 2004, 1/1/2015
Orders/Requests 2005, 2010, 2011
*Examples of methods of destruction: electronic deletion, in-house OR outside contractor shredding, secure recycling, other (describe)
Method of
Destruction (See
examples below')
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 Record's Manager approval: n
Ixj �� .� l iY Division: 2Z1112-Employee Signature: Printed Name:
The Records Manager must sign the approval of this request prior to the destruction of the listed records:
Records Manager Signature: 'L� ) Printed Name: I n I I�34 Date Approved: Z
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Na
Vendor Business Name (if used): Je c i i � , Phone:
Date Records Destroyed:
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.
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 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
Dates Covered
Records Series Title
Records Series
Records Retention
Minimum Retention Period
Description
(Box/Item numbers,
Date Minimum
Method of
Destruction (See
DAN
Schedule
volume, etc.)
Retention Met
examples below*)
GS50-03B-14
Local Government
Retain for 6 years after
28 Boxes —
1986, 1987, 1988, 1989, 1990,
1/1/2020
Financial Disputes
and Collections —
Rev. 3
Common Records
matter resolved then
Accounts
1994, 1995, 1996, 1997, 1998,
General
Retention
Destroy.
Receivable/Payable
1999, 2000, 2001, 2002, 2003,
Schedule (CORE)
2004, 2005, 2006, 2007, 2008,
Version 4.2
2009, 2010, 2011, 2012, 2013
(August 2021)
*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 li ted records must sign below prior to the Record's Manager approval:
Employee Signature: Printed Name:_ VI(I-e, �TG�(1 Division: 12111
The Records Manager must sign the approval of this request rior to the destruction of the listed records: 11
Records Manager Signature: 4�Printed Name: h I Date Approved: l
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Na
Date Records Destroyed:
Vendor Business Name (if used): L Mi 'IC.Y e G • 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 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 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
Method of
Description
Records Series Title
Records Series Records Retention
Minimum Retention Period (Box/Item
Dates Covered
Date Minimum
Destruction (See
DAN Schedule
numbers, volume,
Retention Met
examples below*)
etc.)
Reporting/Filing GS50-03A-17 Local Government
Retain for 5 years after 3 Boxes — W-2's
1996, 1997, 1998, 1999, 2001,
1/1/2023
(Mandatory) — Rev. 1 Common Records
date form/report
2002, 2003, 2004, 2005, 2006,
Internal Revenue Retention
submitted then Destroy.
2007, 2008, 2009, 2010, 2016,
Service (IRS) Schedule (CORE)
2017
Version 4.2
(August 2021)
*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 they<ed3Rcords must sign below
/prior to the Record's Manager approval: /
Employee Signature: W Printed Name: �CJBi ��i Division: [ ���� �� 3
The Records Manager must sign the approval of this request nor to the destruction of the listerd, records:
ftN Records Manager Signature: Printed Name: I I l (� nrn1 I Date Approved: 1 C.
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature:
Printed Name:
Vendor Business Name (if used): Su, mi t. k r j • Phone:
Date Records Destroyed:
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.
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 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)
Description
Records Series Title Records Series Records Retention Minimum Retention Period (Box/Item
DAN Schedule numbers, volume,
State and Local Tax GS50-12D-04 Local Government Retain for 5 years after 1 Box — Excise Tax
Returns Rev. 0 Common Records date of filing then
Retention Destroy.
Schedule (CORE)
Version 4.2
Agency Records
Dates Covered Date Minimum
Retention Met
2004, 2005, 2006, 2007, 2008, 1/1/2023
2009, 2010, 2011, 2012, 2013,
2014, 2015, 2016, 2017
I (August 2021) ( I J 1
*Examples of methods of destruction: electronic deletion, in-house OR outside contractor shredding, secure recycling, other (describe)
Method of j
Destruction (See !
examples below*) I
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 Record's Manager approval:
Employee Signature: _ Printed Name: �^-'}�'� ! 1 / 4 ,/164I Division: Z ��
The Records Manager must sign the ap royal ofKUW�t_
uest pi for to the destruction of the listed records:
Records Manager Signature:6Printed Name: 1 Date Approved: i hd-'2'3
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature:
Vendor Business Name (if used)
Vendor Signature:
Printed Name:
A_I(A,I.-)fd,
Printed
Phone:
Date Records Destroyed:
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
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)
Records Series Title I I
Records Series Records Retention
DAN Schedule
Maintenance —
Minor Non -
Regulated
GS2012-040 Local Government
Rev. 0 Common Records
Retention
Schedule (CORE)
Version 4.2
j Description
Minimum Retention Period jl (Box/Item
numbers, volume,
etc.)
Retain for 3 years after 30 Boxes —
end of fiscal year then Vehicles/Oil/
Destroy. Tuneup/Tire/
Filters
Agency Records
Dates Covered Date Minimum
Retention Met
2003, 2004, 2005, 2006, 2007,
2008, 2009, 2010, 2011, 2012,
2013, 2014, 2015, 2016, 2017,
2018, 2019
1/1/2023
*Examples of methods of destruction: electronic deletion, in-house OR outside contractor shredding, secure recycling, other (describe)
Method of
Destruction (See
examples below*)
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 ecords must sign below prior to the Record's Manager approval:
' J
Employee Signature �' Printed Name: C� /ue 1"/ 11 40-tI1 Division:
The Records Manager must sign the approval of this renuest prior to the destruction of the` listed records: j �7
Records Manager Signature:_ Printed Name: l 1 (A► I r� Date Approved: L
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: p ] ] 1 Printed Name:
Vendor Business Name (if used): SCc ['i�l 1 C. b � 6
Vendor Signature:
Printed Name:
Phone: _
Date Records Destroyed:
Date Records Destroyed:
The retention and disposition action for this Public Records Destruction Cog is "Retain for the life of the agency" pursuant to CORE series GS50-09-05.
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 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
T— Method of
Description
Records Series Title
Records Series
Records Retention
Minimum Retention Period
(Box/Item
Dates Covered Date Minimum
Destruction (See
DAN
Schedule
numbers volume
Retention Met
examples below*)
_
etc.)
Retain for 6 years after
27 Boxes -
Financial Disputes
GS50-03B-14
Local Government
1987, 1996, 1997, 1998, 2001, 1/1/2020
and Collections -
Rev. 3
Common Records
matter resolved then
Accounts
2002, 2003, 2004, 2005, 2006,
General
Retention
Destroy.
Receivable and
2007, 2008, 2009, 2010, 2011,
Schedule (CORE)
Payable
2012, 2013
Version 4.2
(August 2021)
*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 liste
recor
must sign below prior to the Record's M Hager approval:
Employee Signature:
� r ��
Printed Name: �- /
�7
Division: �2 / �� Av
The Records Manager must sign the appr val of this r quest prior to the destruction of the listed records: y �,
Records Manager Signature:—L \ Printed Name: I
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: l _Printed Name:
Vendor Business Name (if used): se-C l[ _ I` 1 e J , Phone:_
Vendor Signature:_ _ _. Printed Name:
Date Approved:J 1 Z S
Date Records Destroyed:
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 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 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
Method of
Description
Records Series Title
Records Series
Records Retention
Minimum Retention Period
(Box/Item
Dates Covered
Date Minimum
Destruction (See
DAN
Schedule
I
numbers, volume
Retention Met
examples below*)
Retain for 4 years after
etc.)
Leave/Overtime -
GS50-04B-09
Local Government
2 Boxes —
2003, 2004, 2005, 2006, 2007,
1/1/2019
Routine
Rev. 2
Common Records
end of fiscal year or until
Payroll/Overtime/
2008, 2010, 2011, 2012, 2014
Retention
completion of State
Leave
Schedule (CORE)
Auditor's examination
Version 4.2
report, whichever is
(August 2021)
sooner 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 lis d recor,4s must sign below prior to the Record's Manager approval:
Employee Signature: /!/C/ Printed Name: 74:)4/ Division:
The Records Manager must sign the ap roval of this re uest prio to the destruction of the listed records:
Records Manager Signature: Printed Name: I I l�
The person/people responsible for the destruction of records must sign upon destruction of the listed records:
Employee Signature: Printed Name:
Vendor Business Name (if used): 5f_ r A�1 Li CIC k-�t CI
Vendor Sig
Printed Name:
Pho
Date Approved: I L I 3
Date Records Destroyed:
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
CERTIFICATE OF DESTRUCTION
Name: CO OP CITY OF BREMERTON
Address: 100 OYSTER BAY AVE S
City: BREMERTON 98312
Phone: 360-473-2316
Request: RR -PT
Le MoVMobile s��40fl INFp��
11,11 ING �i 10/600/1 Fle'1101111 16, 111 -W/, 101
P" 0"' �-/'//Ilh rrillfillf", arn"
Account #: 2185- 952778-1100 Invoice Date: 12/4/2023 Route Id: TSP1 Ticket #: 1676450
On the date shown, Designated Confidential Data was Shredded and Destroyed as per Customers Instructions.
CUSTOMER COPY
Service
Description
ty Rate
Amount
SHPURGE
1.00 SHRED ONE TIME PURGE
43.80
537_ ZG
SHEXB
1.00 SHRED EXTRA BOX
4.38
Driver Signature: - 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