FROM: Animal Services
title
SUBJECT: Test Item - Form 11 header as an image
body
RECOMMENDED MOTION: That the Board of Supervisors:
1. First action recommended to the Supervisors. Motions are the only binding actions on the form 11. They should be clear, legally defensible, and accomplish what needs to be done to complete the action you are recommending to the Board.
2. Additional, as needed.
ACTIONS:
Consent
-----------------------------------------------------------------------------
John Hildebrand, Planning Director, 08/24/2026
Table 1: FINANCIAL DATA
|
COST DATA |
Current Fiscal Year |
Next Fiscal Year |
Total Cost |
Ongoing Cost |
|
COST |
$ partial year |
$ full year |
$ (e.g. contract total) |
$ (e.g. Operations) |
|
NET COUNTY COST |
$ partial year |
$ full year |
$ In dollars, no cents |
$ In dollars, no cents |
Table 2: SOURCE OF FUNDS
|
FUND NAME OR NUMBER |
Budget Adjustment |
For Fiscal Year |
|
Give fund name or number. If external, give source (e.g. state grant, contract revenue). If multiple, give percent of each. |
Yes or No |
YYYY/YYYY |
CHIEF EXECUTIVE OFFICER (CEO) RECOMMENDATION: [CEO use]
BACKGROUND:
Summary
Briefly summarizes the recommended action. The summary should include the critical information needed for the Board members to make an informed decision about whether or not to support the action.
Impact on Residents and Businesses
Explain briefly the expected impact on private residents or private businesses. Use general terms and very rough estimates. Rely on department expertise. Do not use intensive research or consultants.
Additional Fiscal Information
Summarize the full cost of the item before the Board. Describe the source(s) of funding. Include an explanation of new/ongoing costs not explicitly in the Form 11 (i.e., the operations cost of a new building).
Clearly show the cost per year for all years to be approved. For example, a 5-year contract should show the cost of each of the 5 years. Show the total cost of the asked-for Board action. This total cost is to be included at the end of the Subject section on the Form 11’s first page in [Brackets].
Contract History and Price Reasonableness
Briefly summarize contract terms. Is this a renewal? If so, how long has the contract been in place and is there a cost change recommended? What actions have Purchasing and the department taken to ensure the cost is reasonable (e.g., summarize RFP process).
SUPPLEMENTAL (if needed, OR delete this section):
[For informational purposes only. Delete the data in this section before finalizing your Form 11.]
(If the Change Order Table is needed, copy and paste it into your Change Order Report)
ATTACHMENTS (if any, in this order):
SCHEDULE A. BUDGET ADJUSTMENT
No change to past requirements.
ATTACHMENT. CHANGE ORDER REPORT
Include a table like the one below.
Table 3: CHANGE ORDER (CO)
|
CO NUMBER |
AMOUNT |
PERCENT |
DESCRIPTION |
|
Not Applicable (N/A) |
$ Original contract amount |
N/A |
N/A |
|
All previously-approved CO |
$ Total CO cost of all previous approved CO |
Cost/original % |
|
|
CO number |
$ CO cost |
Cost/original % |
Brief description, including cause, and whether initiated by county or contractor |
|
Additional CO number |
$ CO cost |
Cost/original % |
Brief description, including cause, and whether initiated by county or contractor |
|
Additional CO number |
$ CO cost |
Cost/original % |
Brief description, including cause, and whether initiated by county or contractor |
Table 4: CONTRACT COST
|
NEW TOTAL CONTRACT COST |
TOTAL CO/ORIGINAL |
CO TOTAL |
NEW CONTRACT TOTAL |
|
$ New total contract cost |
$ Total CO/Original |
$ CO total |
$ New contract total |
Additional description and details of new change order(s) - one or two paragraphs for each.
ATTACHMENT C. PERSONNEL CHANGE and ORDINANCE 440 REPORT
No change to past requirements.
Brianna Lontajo, Principal Management Analyst , 08/26/2026