HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Human Resources; 2019-04-18 (3)1
RECORDS DESTRUCTION AUTHORIZATION FORM
DATE: 3/6/19
REQUESTING DEPARTMENT: HR -----------
DESTRUCTION APPROVALS:
REQUESTER: Kim Stankavich
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pendi g or ongoing litigation or investigation involving these records is known to exist.
CITY ATTORNEY DATE
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS TAB BARCODE
PERIOD (if applicable)
BENEFITS ( t h4J1de f;Jy-,ns) 1997 -2001 0830-)6 CU+6 ;V/A 05"
*If more spaces are needed, click in the last box in right hand corner of table and hit "tab". This will create more fields in the table.
To be filled out once records have been destroyed.
RECORD DESTRUCTION COMPLETED BY: -------~-~,Juu~----
CERTIFICATE OF DESTRUCTION? g7' YES O NO
DATE:
TAB BARCODES DELETED BY: DATE: ---------------------
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
<_~, rn, o• Revised: 2016
w CARLSBAD p a g e / 1
CERTIFICATE OF DESTRUCTION & RECYCLING
This certificate is presented to: CITY OF CARLSBAD -RECORDS MANAGEMENT DIVISION
Per the express request of Client, Corodata has received the Material referred to below and has/will destroy and then
recycle said Material in accordance with its standard procedures. As the parties have agreed, Corodata will not
inventory, record or track any information contained within or related to the Material.
Account #(s)
Certificate #
Date Issued
Service Locations
Date Range of Service
Work Ticket(s)
Quantity/Item
SD012455
110232
Monday, April 22, 2019
5815 EL CAMINO REAL
Apr-18-2019 thru Apr-18-2019
577291
41 -41 Boxes for Destruction ( standard)
• Nothing in this certificate shall be deemed to modify the terms of the parties" Service Agreement(s) or Work Ticket(s).
E•Jcorodata ~SSAE16
Type II Audil Completed HIP.At\