HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Building; 2022-04-21 (2)This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 2021
Page | 1
DATE: 2/15/2022
REQUESTING DEPARTMENT: BUILDING VERONICA WILLIAMS
DESTRUCTION APPROVALS:
We certify that the records listed below have been retained for the scheduled retention period, required audits have been
completed, and no pending or ongoing litigation or investigation involving these records is known to exist.
DEPT. HEAD/DIVISION MANAGER DATE RECORDS MANAGEMENT DATE CITY ATTORNEY DATE
*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: ___________________________ DATE: ______________
CERTIFICATE OF DESTRUCTION? YES NO
TAB BARCODES DELETED BY: _____ _______________________________ DATE: ______________
BOX NO. RECORDS DESCRIPTION DATED RRS NO. RRS
PERIOD
TAB BARCODE
(if applicable)
1
Copies of Private Party Permits / Minor Special Events (No Impact on Public Property) 2020-2021 CW-105
Copies - When No Longer Required
RECORDS DESTRUCTION AUTHORIZATION FORM
N/A
2/15/22 02/15/2022 3/31/2022
CORODATA 4/21/2022
X
-- --
C cityof
Carlsbad
□ □
Account #(s)SD012455
Certificate #101558
Date Issued Friday, April 22, 2022
Service Locations 5815 EL CAMINO REAL
Date Range of Service Apr-21-2022 thru Apr-21-2022
Work Ticket(s)958844
Quantity/Item
1 -CALL 20 MINUTES RPIOR TO
ARRIVAL - 760-271-6841
46 -46 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).
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.
E•Jcoro data SSAE16
Type II Audit Completed • HIPA'A
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