6G(1) Agreement for Services - Laserfiche WebLink

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5. Name(s) of Contractor(s) or Vendor(s): 6. Description(s) of Contract(s) or Purchase(s) (Describe the kind of contact involved, and the effective date and terns of the contract or purchase if reasonably determinable. Dates required if 4(a) is selected above. If "dependent" is involved, provide dependent's name and relationship): 7. Description of My Financial Interest (Describe in what manner the public servant or "dependent" expects to derive a profit or financial benefit from, or otherwise has a pecuniary interest in, the above contract(s) or purchase(s); if reasonably determinable, state the approximate dollar value of such profit or benefit.): (Attach extra pages i f additional ,puce is needed) 8. Approval of Appointing Officer or Bodv (To be completed if the public servant was appointed by an elected public servant or the board of trustees of aatate-supported college or university): I (We) being the of (Title of Officer or Name of Go~~erizing Bodti) and having the power to appoint (Name of Go~~ef~nmc~ntal Entity) the above named public servant to the public position to which he or she holds, hereby approve fl1e pal-ticipation to the appointed disclosing public servant in the above described contract(s) or purchase(s) in which said public servant has a conflict of interest as defined in Indiana Code 35- 44-1-3; however, this approval does not waive any objection to any conflict prohibited by statute, rule, or regulation and is not to be construed as a consent to any illegal act. Elected Official Office 13