RECEIPT FOR ENERGY COMMISSION LETTER REGARDING NEW DUCT SEALING

							 BOARD OF COUNTY COMMISSIONERS                  TRANSMITTAL AND RECEIPT                                 PAGE 1
 BROWARD COUNTY, FLORIDA                          FOR RECORDS STORAGE                                   OF     _____ PAGES
 COUNTY RECORDS DIVISION


 SEND ORIGINAL TO:                                                       ITEM # 1 TO BE COMPLETED BY RECORDS CENTER
                                                                         1. ACCESSION #
          BROWARD COUNTY RECORDS CENTER
          1600 W HILLSBORO BLVD
          DEERFIELD BEACH, FL 33441                                      2.AGENCY CODE (4 CHARACTERS)




                                                                         3. FROM: (NAME & ADDRESS OF SUBMITTING AGENCY)




 4. AGENCY CONTACT                                                       5. LOCATION                    6. TELEPHONE #


 7. CUSTODIAN (SIGNATURE)                                                8. TITLE                        9. DATE


 10A. RESTRICTION ON USE OF RECORDS IF ANY)                              10B. CITE AUTHORITY            11. CUBIC FEET TRANSFERRED




  RECORDS
I IDENTIFIERS



 12. LIST OF RECORDS TRANSFERRED (ITEM 12A TO BE COMPLETED BY RECORDS CENTER)


 A. RC BOX        B. AGENCY         C. RECORDS SERIES TITLE                    DATES               D. RECORDS        AGENCY USE


                                                                     FROM              TO




 TOTAL

1. SEND ORIGINAL TO RECORDS CENTER                            3. RETAIN (1) COPY UNTIL APPROVED FORM IS RETURNED
2. PLACE (1) COPY IN FIRST BOX OF SHIPMENT                    4. RETAIN APPROVED FORM FOR AGENCY FILE
CONTROL FORM 404-21 (REV.1/92)
a.   Indicate the number of pages included in this shipment.

                 b.    Item (1) is for RECORDS CENTER USE ONLY.

                 c.    Items (2-13) are as follows:

                       2.     AGENCY CODE - This is the four character code that identifies your
                              agency in the Records Management Computer Program. The
                              Department Listing of agency codes in WordPerfect format is on the
                              RCW.

                       3.     FROM - Fill out the name and address of the agency.

                       4.     AGENCY CONTACT - Put the name of the Records Management
                              Coordinator here. This is the name of the person filling out the
                              Transmittal.

                       5.     LOCATION- The building and room number where the records are
                              currently housed. EX. - GC 114, MR 3rd fl., or GC ANNEX 302.

                       6.     TELEPHONE # - The Records Management Coordinator’s phone
                              number. Do not put the main office number here.

                7.     CUSTODIAN - The signature of the agency director or in his or her absence,
                       the assistant director or Sub-custodian.

                8.     TITLE - Of the Custodian who signs the form.

                9.     DATE - The day the form is completed.

                10a.   RESTRICTION ON USE - Are these records confidential and exempt from
                       the Public Records Act?

                10b.   CITE AUTHORITY - If the answer to (10.a) is yes, write the statutory citation
                       that validates an exemption from the Public Records Act for these records.

                11.    CUBIC FEET - A record storage box equals roughly one cubic foot. Count
                       the number of boxes in this shipment and enter that number here. This
                       number is automatically calculated on the electronic form.

                12a.   FOR RECORDS CENTER USE ONLY

                12b.   AGENCY BOX # - Start the box numbers at 1 for each shipment. Write the
                       box number with a black wide-tip marker in the top left corner of a handle
             end on each box. Do not write anything else on the handle ends of the box.

      12c.   RECORD SERIES TITLE - Indicate the exact record series title from the
             retention schedule you are using. Do not enter anything other than a
             current State published record series title in this field. By assigning a
             Record Series Title and its corresponding Record Series Number
             (instruction 12d.) to the records in the box, the records are being scheduled
             for retention and ultimate destruction. Only records that have been
             scheduled are accepted by the Records Center. The from and to dates are
             essential and must be included.

      12d.   RECORD SERIES NUMBER - If you are using the General Records
             Schedule for Local Government Agencies (GS1), or another general records
             schedule, the prefix, a dash, the item number, and the copy indicator must
             be included. EX. - GS1- 6A (ATTENDANCE RECORDS), GS4-70A (RUN
             REPORTS: EMERGENCY), or GS2- 53A (INMATE INCARCERATION
             RECORDS). In the first example (GS1) is the prefix, (6) is the item number,
             and (A) is the master copy indicator. Do not enter anything other than a
             current State published record series number in this field.

      13.    TOTAL # OF BOXES - Add the number of boxes included in this shipment
             and put the total here. If using 404-21 continuation sheet(s), put the total
             number of boxes on the last sheet of the shipment. This number is
             automatically calculated on the electronic form.

d.    Two new fields have been incorporated in the transmittal that are optional and
      strictly for agency use. These fields are RECORDS IDENTIFIER(S) and AGENCY
      USE (RANGE). Both fields have a double line border. These fields will enable
      limited indexing capability for the agency, if used. If an agency requires a more
      detailed index, it must be generated on a separate document.

e.    A copy of the transmittal must be faxed to the Records Center for approval. The
      Fax number is (831-1438). The transmittal will not be approved unless it is
      completed correctly. The original Transmittal and Receipt for Records Storage
      form are then sent to the Records Center. If Facilities Management is needed to
      pick up and deliver the boxes, fill out a Service Requisition Form 104, attach it to
      the original 404-21, and forward both forms to the Records Center.

f.    Put a copy of the 404-21 in the first box of this shipment.

g. Keep a file copy of the 404-21 until it can be replaced with the final copy that will be
   forwarded from the Records Center after the shipment has been processed. Attach the
   final 404-21 to your index. The final 404-21 contains Records Center RC Box Number
   information that you must have to accomplish records retrieval from the Records
   Center in the future.