HomeMy WebLinkAbout05.a.02 Asset Disposal AGENDA ITEM 5-a.2.a
REQUEST FOR SURPLUS DECLARATION AND/OR
ASSET DISPOSAL AUTHORIZATION
06/03/25
Asset Number Description Cost Per Unit Acquired Date Book Value
14078 Xerox WC5355 Cinderella-Call Center $ 3,297.00 01/01/2014 $
15526 XEROX B7035H $ 3,278.00 03/03/2018 $ 429.28
Clay County Utility Authority
Equipment Update Form
Disposal/Surplus Section:
® Dispose ❑ Surplus Placement Surplus Removal
Placement Location:
(If Requesting Disposal, please indicate reason below)
Lost ® Obsolete Date Agenda Approved
❑Cannibalized n Stolen / Vandalized -
I-I Damaged ❑ Returned to Vendor
* If Stolen / Vandalized, please provide a copy of the police report.
Asset # Item Description (Make/Model/BV) Serial #
14078 Xerox Workcentre 5335 (1/10/2014) BV: $0.0 AE9900371
15526 Xerox VersaLink B7035 (02/28/2018) BV: $429.27 5DA090370
Dept Name: Admin (IT) Requested by: Jacob Rutkowski
Dept Head Approval: Date: 5/16/2025
Final Disposal Details
Method of Disposal: Sensible Recycling Date:
Details/Comments: J.D. wills schedule / coordinate pickup upon Board approval
Person Disposing: J.D and Jacob Date:
Witness: Date:
Transfer/Loan Section (Between departmental offices):
❑ Transfer I I Loan
Asset # Item Description (Make/Model) Serial # Est Rtrn Date
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: ��11 2Custodian:
Today's Date: ,S- //, - 2 5 Today's Date: