HomeMy WebLinkAbout; ; Records Destruction Authorization Form-Housing & Homeless Services; 2022-12-29 (2)This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 2021
P a g e | 1
DATE: NOV.10,2022
REQUESTING DEPARTMENT:HOUSING &HMLS SERVICES REQUESTER:LEAH SORENSEN
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
BOX NO. RECORDS DESCRIPTION DATED RRS NO.
RRS
PERIOD
TAB BARCODE
(if applicable)
1 Affordable Housing- Harvey,
Craig James: 1313 Verbena Ct.
1999
(closed 2001)HS-035
Loan
Pay-off
+ 5 yrs.
H0001143/ 056050
1 Affordable Housing-Gugliemelli,
Mario: 1322 Statice Ct.
1999
(closed 2005)HS-035
Loan
Pay-off
+ 5 yrs.
H0001146/056050
1 Affordable Housing- Dvilac,
Helen: 6162 Paseo Picador
2001
(closed 2004)HS-035
Loan
Pay-off
+ 5 yrs.
H0000650/056050
1 Affordable Housing- Brice,
Kristen: 1304 Phlox Ct #4
1999
(closed 2001)HS-035
Loan
Pay-off
+ 5 yrs.
H0001133/056050
1 Affordable Housing- Pierce,
Robert & Lynn: 1319 Statice Ct.
1999
(closed 2000)HS-035
Loan
Pay-off
+ 5 yrs.
H0001200/056050
1 Affordable Housing- Thompson,
Asia: 6536 Easy St.
1988
(closed 1993)HS-035
Loan
Pay-off
+ 5 yrs.
H0001218/056050
1 Affordable Housing-Martineau,
Marilyn: 7575 Caloma Cr.
2009
(closed 2014)HS-035
Loan
Pay-off
+ 5 yrs.
H0004764/056050
RECORDS DESTRUCTION AUTHORIZATION FORM
DocuSign Envelope ID: B0232A4C-53CD-4E03-937B-A4BE3858EED1
DATE: Nov. 10, 2022
REQUESTING DEPARTMENT: HOUSING & HMLS SERVICES REQUESTER: LEAH SORENSEN
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.
a .... ~ Milli 1111012022
DEPT. HEAD/DIVISION MANAGER DATE
{'"city of
Carlsbad
RECORDS MANAGEMENT
11/17/2022 11/22/2022
DATE CITY ATTORNEY DATE
This form documents the destruction of City records in accordance with the City of Carlsbad Records Management Program.
Revised: 2021
P a g e | 2
*If more spaces are needed 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:______________
CORODATA 12/29/2022
X
12/29/2022
DocuSign Envelope ID: B0232A4C-53CD-4E03-937B-A4BE3858EED1
, click in the last box in right hand corner of table and hit "tab". This will create mare
{'"city of
Carlsbad
□
_ Mana fr11ery
□
RECORDS DESTRUCTION REPORT
Maria Emery
DATE: 11/29/2022
TEMPLATE NAME: Physical Folder
TOTAL RECORD COUNT: 7
COMMENTS: Affordable Housing Destruction
ENTRY ID REVIEW DATE NAME FILE NUMBER
4347734 11/29/2022 BRICE, KIRSTEN; 1304 PHLOX CT #4;
AFFORDABLE HOUSING
056050
4347711 11/29/2022 D'VILAC, HELEN; 6162 PASEO PICADOR;
AFFORDABLE HOUSING
056050
4356837 11/29/2022 GUGLIEMELLI, MARIO; 1322 STATICE CT;
AFFORDABLE HOUSING
056050
4356844 11/29/2022 HARVEY, CRAIG JAMES; 1313 VERBENA CT;
AFFORDABLE HOUSING
056050
4355008 11/29/2022 MARTINEAU, MARILYN; 7575 CALOMA CR;
AFFORDABLE HOUSING
056050
4347729 11/29/2022 PIERCE, ROBERT & LYNN; 1319 STATICE
COURT; AFFORDABLE HOUSING
056050
4356761 11/29/2022 THOMPSON, ASTA; 6536 EASY STREET;
AFFORDABLE HOUSING
056050
·tyof
lsbad
Ca li fornia
Account #(s)SD012455
Certificate #102136
Date Issued Wednesday, January 04, 2023
Service Locations 5815 EL CAMINO REAL
Date Range of Service Dec-29-2022 thru Dec-29-2022
Work Ticket(s)1067282
Quantity/Item 69 -69 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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