HomeMy WebLinkAbout5-a.2.a Asset Disposal AGENDA ITEM 5-a.2.a
REQUEST FOR SURPLUS DECLARATION AND/OR
ASSET DISPOSAL AUTHORIZATION
09/05/23
Description Cost Per Unit Acquired Date Book Value
57-inch mondopad TV/Video small conference room $ 6,092.00 6/21/2016 0.00
ca
s
0
4-
4-
a>
Clay County Utility Authority
Equipment Update Form
Disposal/Surplus Section:
Dispose ❑ Surplus Placement ❑ Surplus Removal
Placement Location:
(If Requesting Disposal, please indicate reason below)
U Lost ® Obsolete Date Agenda Approved
❑ Cannibalized [i Stolen / Vandalized
❑ Damaged ❑ Returned to Vendor
* If Stolen / Vandalized, please provide a copy of the police report.
'Asset # Item Description (Make/Model/BV) Serial #
14817 InFocus Mondopad (7/6/2016) BV: SO.0 buv51155927646
Dept Name: Admin (IT) Requested by:
Dept Head Approval: A_ (C1:,--: __ Dater /?3
Final Disposal Details //�
Method of Disposal: Sensible Recycling Date: 8/18/2023
Details/Comments: _
Person Disposing: Date: 8/18/2023
Witness: Date: 8/18/2023
Transfer/Loan Section (Between departmental offices):
1 ! Transfer I 1 Loan
Asset # Item Description (Make/Model) Serial # Est Rtrn Date
r .
I acknowledge receipt of the above referenced equipment. I will return this equipment
when it is no longer required in the same condition, or better than I received it.
Grantor (from) Grantee (to)
•
Dept Name: Admin (IT) Dept Name:
Custodian: Custodian:
Today's Date: 'Today's Date: