HomeMy WebLinkAbout05.a.02 Asset Disposal AGENDA ITEM 5-a.2.a
REQUEST FOR SURPLUS DECLARATION AND/OR
ASSET DISPOSAL AUTHORIZATION
02/03/26
Asset# Description Serial#
13812 Ice-O-Matic Ice Machine 13021280012960
13812 Manitowoc Ice Machine 1120135704
6934 Wall Rack N/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)
Lost ❑■ Obsolete Date Agenda Approved
Cannibalized ❑Stolen / Vandalized *
^ Damaged ❑Returned to Vendor
* If Stolen / Vandalized, please provide a copy of the police report.
Asset # Item Description (Make/Model) Serial #
14722 Manitowoc Ice Machine only 1120135704
13812 IceOMatic Ice Machine only 13021280012960
6934 Wall Rack from Maintenance Building N/A
Dept Name: Facilities ------Requested by: James Moore
Dept Head Approval: t Y Date: /06
p
Final Disposal Details C
Method of Disposal: Dis d/ter (p Date:
Details/Comments: Vendor Disposed of assets after installation of new units (EPA)
Person Disposing: J. Moore Date: /
Witness: J Foshee Date:
Transfer/Loan Section (Between departmental offices):
❑ Transfer ❑ 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: Dept Name:
Custodian: Custodian:
Today's Date: Today's Date: