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ACTION
From
From
From
To
1. Department Employee Relations
2. Agenda Item # (if available)
Budgetary Impact Analysis
Division Human Resources
3. 'Title and brief description of legislation or attach ordinance/resolution:
Fire -Rescue Annual Physical Examination Services for designated personnel to be
provided by Mercy Medical Development dlb/a Mercy Outpatient Center, per RFP 03-04-
080.
4. Is this item related to revenue? NO: X YES (If yes, skip to item #7.)
5. Are there sufficient funds in Line Item?
YES: • X Index Code 280401 Minor Obj. Code 260 Amount $603,500
NO: Complete the following questions: and 280601.6.260
6 . Source of funds: General Fund Amount budgeted in the Line Item $ 603,500
Balance in Line Item $
Amount needed in the Line item
$
Sufficient funds will be transferred from the following' line items:
ACCOUNT NAME
ACCOUNT NUMBER
Index/Minor Object/Project No.
TOTAL
7. Any additional comments?
8. Approved by: ti'
Verified b
Department. Director/Designee
FOR DEPARTMENT OF MANAGEMENT AND BUDGET USE ONLY
Verifi40 by: Transfer done by:
Department of : gement and Budget
Director/Designee
sd.
Budget Analyst
Date
Date
Budget Analyst
Date
Date