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Home My WebLink About; ; Records Destruction Authorization Form-Housing & Homeless Services; 2023-03-23 (4)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: 12/29/22 REQUESTING DEPARTMENT:HOUSING &HOMELESS SERVICES REQUESTER:NICOLE PIANO-JONES 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) CDBG1.22 Meals on Wheels Meal Delivery Service FY 2013-14 HS-010 Min. 5 Years H0004773 CDBG1.22 North County Community Services Food Bank FY 2013-14 HS-010 Min. 5 Years H0004774 CDBG1.22 Alternatives to Abuse Shelter FY 2013-14 HS-010 Min. 5 Years H0004777 CDBG1.22 YMCA Oz Youth Shelter FY 2013-14 HS-010 Min. 5 Years H0004778 CDBG1.22 Community Resource Center Homelessness Prevention FY 2013-14 HS-010 Min. 5 Years H0004771 CDBG1.22 Brother Benno Brother Benno Center FY 2013-14 HS-010 Min. 5 Years H00047?? CDBG1.22 Casa de Amparo Food Program FY 2013-14 HS-010 Min. 5 Years H0004760? CDBG1.22 Catholic Charities La Posada de Guadalupe FY 2013-14 HS-010 Min. 5 Years H0004770 CDBG1.22 Senior Meal Program FY 2013-14 HS-010 Min. 5 Years H0004776 CDBG1.22 Teen Scene FY 2013-14 HS-010 Min. 5 Years H00047?7 CDBG1.22 Center for Social Advocacy Fair Housing Program FY 2013-14 HS-010 Min. 5 Years H0004781 CDBG1.22 North County Lifeline Youth Counseling Program FY 2013-14 HS-010 Min. 5 Years H0004775 CDBG1.22 Interfaith Community Services Housing FY 2012-13 HS-010 Min. 5 Years H0004616 RECORDS DESTRUCTION AUTHORIZATION FORM DocuSign Envelope ID: 36046109-38E2-4FE2-B824-D8CFED663C97 DATE: 12/29/22 REQUESTING DEPARTMENT: HOUSING & HOMELESS SERVICES REQUESTER: NICOLE PIANO-JONES 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. &aid, &ills 1/17/2023 DEPT. HE~D/DIVISION MANAGER DATE RECORDS MANAGEMENT - - Women's Resource Center- {'"city of Carlsbad - - - The Angel's Depot- Boy's and Girls Club - - - - - 1/17/2023 1/18/2023 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 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:______________ CDBG1.22 Meals on Wheels Meal Delivery Service FY 2012-13 HS-010 Min. 5 Years H0004617 CDBG1.22 North County Community Services Food Bank FY 2012-13 HS-010 Min. 5 Years H0004618 CDBG1.22 North County Lifeline Youth Counseling Program FY 2012-13 HS-010 Min. 5 Years H0004619 CDBG1.22 Senior Meal Program FY 2012-13 HS-010 Min. 5 Years H0004620 CDBG1.22 YMCA Oz Youth Shelter FY 2012-13 HS-010 Min. 5 Years H0004622 CDBG1.22 Pedestrian Railway Crossing Chestnut Ave FY 2012-13 HS-010 Min. 5 Years H0004627 CDBG1.22 Boys & Girls Club Facility Improvements FY 2012-13 HS-010 Min. 5 Years H0004623 CDBG1.22 Center for Social Advocacy Fair Housing Program FY 2012-13 HS-010 Min. 5 Years H0004626 CDBG1.22 Boys & Girls Club Teen Scene Program FY 2012-13 HS-010 Min. 5 Years H0004611 CDBG1.22 Brother Benno Brother Benno Center FY 2012-13 HS-010 Min. 5 Years H0004612 CDBG1.22 Casa de Amparo Food Program FY 2012-13 HS-010 Min. 5 Years H0004613 CDBG1.22 Catholic Charities La Posada de Guadalupe FY 2012-13 HS-010 Min. 5 Years H0004614 CDBG1.22 Community Resource Center Homelessness Prevention FY 2012-13 HS-010 Min. 5 Years H0004615 CDBG1.22 - Alternatives to Abuse Shelter FY 2012-13 HS-010 Min. 5 Years H0004621 CORODATA 3/23/2023 X MARIA EMERY 3/23/2023 DocuSign Envelope ID: 36046109-38E2-4FE2-B824-D8CFED663C97 C ciryof Carlsbad - - - The Angel's Depot- - - - - - - - - - Women's Resource Center , click in the last bax in right hand corner of table and hit "tab". This will create more fields in the □ □ RECORDS DESTRUCTION REPORT Maria Emery DATE: 1/18/2023 TEMPLATE NAME: Physical Folder TOTAL RECORD COUNT: 27 COMMENTS: ENTRY ID REVIEW DATE NAME FILE NUMBER 4355226 01/18/2023 BOYS & GIRLS CLUB; FACILITY IMPROVEMENTS; CDBG 056530 4355250 01/18/2023 BOYS & GIRLS CLUB; TEEN SCENE PROGRAM; CDBG 056530 4355002 01/18/2023 BOYS & GIRLS CLUB; TEEN SCENE PROGRAM; CDBG (2) 056530 4355249 01/18/2023 BROTHER BENNO; BROTHER BENNO CENTER; CDBG 056530 4355000 01/18/2023 BROTHER BENNO; BROTHER BENNO CENTER; CDBG (3) 056530 4355246 01/18/2023 CASA DE AMPARO; FOOD PROGRAM; CDBG 056530 4354998 01/18/2023 CASA DE AMPARO; FOOD PROGRAM; CDBG (3) 056530 4355244 01/18/2023 CATHOLIC CHARITIES; LA POSADA DE GUADALUPE; CDBG 056530 4354996 01/18/2023 CATHOLIC CHARITIES; LA POSADA DE GUADALUPE; CDBG (4) 056530 4355221 01/18/2023 CENTER FOR SOCIAL ADVOCACY; FAIR HOUSING PROGRAM; CDBG 056530 4354974 01/18/2023 CENTER FOR SOCIAL ADVOCACY; FAIR HOUSING PROGRAM; CDBG (3) 056530 4355242 01/18/2023 COMMUNITY RESOURCE CENTER; HOMELESS PREVENTION; CDBG 056530 4354994 01/18/2023 COMMUNITY RESOURCE CENTER; HOMELESS PREVENTION; CDBG (3) 056530 4355241 01/18/2023 INTERFAITH COMMUNITY SERVICES; HOUSING; CDBG 056530 4355238 01/18/2023 MEALS ON WHEELS; MEAL DELIVERY SERVICE; CDBG 056530 4354990 01/18/2023 MEALS ON WHEELS; MEAL DELIVERY SERVICE; CDBG (3) 056530 ·tyof lsbad Ca li fornia 4355237 01/18/2023 NORTH COUNTY COMMUNITY SERVICES; FOOD BANK; CDBG 056530 4354988 01/18/2023 NORTH COUNTY COMMUNITY SERVICES; FOOD BANK; CDBG (3) 056530 4355234 01/18/2023 NORTH COUNTY LIFELINE; YOUTH COUNSELING PROGRAM; CDBG 056530 4354986 01/18/2023 NORTH COUNTY LIFELINE; YOUTH COUNSELING PROGRAM; CDBG (2) 056530 4355219 01/18/2023 PEDESTRIAN RAILWAY CROSSING; CHESTNUT AVE.; CDBG 056530 4355232 01/18/2023 THE ANGEL'S DEPOT; SENIORS MEAL PROGRAM; CDBG 056530 4354984 01/18/2023 THE ANGEL'S DEPOT; SENIORS MEAL PROGRAM; CDBG (2) 056530 4355231 01/18/2023 WOMEN'S RESOURCE CENTER; ALTERNATIVES TO ABUSE SHELTER; CDBG 056530 4354982 01/18/2023 WOMEN'S RESOURCE CENTER; ALTERNATIVES TO ABUSE SHELTER; CDBG (2) 056530 4355229 01/18/2023 YMCA OZ; YOUTH SHELTER; CDBG 056530 4354980 01/18/2023 YMCA OZ; YOUTH SHELTER; CDBG (2)056530 Account #(s)SD012455 Certificate #102247 Date Issued Friday, March 24, 2023 Service Locations 5815 EL CAMINO REAL Date Range of Service Mar-23-2023 thru Mar-23-2023 Work Ticket(s)1109694 Quantity/Item 40 -40 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•Jcorodata -tl HIPA'A GIJIJlll!affl