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Home My Public Portal AboutResolution #2008-40, A Resolution Revising The Request Form For Iowa Code Chapter 22 Public Record Requests Ir ,�Y. RESOLUTION# 2008-40 A RESOLUTION REVISING THE REQUEST FORM FOR IOWA CODE CHAPTER 22 PUBLIC RECORDS REQUESTS. WHEREAS,the Riverdale City Council adopted a revised Records Request Form for Iowa Code Chapter 22 Public Records requests; and WHEREAS,the Records Request Form must be updated to denote acceptance and receipt of the requested documents by the recipient thereof; and WHEREAS,the"For Office Use Only" section at the bottom of the Records Request Form is no longer administratively useful. NOW, THEREFORE, BE IT RESOLVED, that the City Council of the City of Riverdale, Iowa, adopts the attached Records Request Form for public records requests. This Resolution shall take immediate effect. PASSED,APPROVED AND ADOPTED THIS 16th day of December, 2008. Ayes: Nays: Franklin Channon Hupp Littrel Halsey _ . ayor ATTEST: heresa Ralfs, City Cler City of Riverdale,Iowa 11 Records Request Form Name (Full Legal Name) Address Description of Records Requested: REQUEST ❑Request made in writing ❑Requesting ❑Request made verbally ❑Email ❑Copies ❑Phone message ❑Facsimile ❑View originals ❑Direct phone conversation ❑Postal mail ❑In-person ❑In-person Submitted on: (Date and Time) Request processed on: (Date and Time) Estimate of fees,if applicable:$ Advance deposit retained,if applicable:$ 10 Business Days from Request: (Date and Time) Note: A reasonable delay is permissible to determine if the record is a confidential record,but the delay shall not exceed twenty calendar days and ordinarily should not exceed ten business days. 20 Calendar Days for Submission: (Date and Time) Date on Which Legal Counsel's Opinion Sought: NOTIFICATION Notified that documents are ready for(select one)❑pick-up at City Hall during posted hours,❑pick-up at City Hall by appointment(date and time as listed below)❑examination of the original at City Hall during posted hours, ❑examination of the original at City Hall by appointment(date and time as listed below),or ❑documents will be mailed to the individual via certified mail at the individual's expense. 1. (Date)and _(Time) ❑In-person❑phone message❑direct phone conversation❑email(check all that apply) 2. (Date)and (Time) ❑In-person❑phone message❑direct phone conversation❑email(check all that apply) Notes or Special Requests: Appointments are available between 9:00 a.m.and 12:00 p.m.and 1:00 p.m.and 4:00 p.m.Monday through Friday,excluding legal holidays. A copy of the Fee Schedule,which outlines the fees applicable to public records requests,is available free of charge. Please note,original documents will be made available for review under the supervision of the custodian with the exception of documents that contain confidential information as provided by both federal and state law including but not limited to Iowa Code Section 22.7,HIPAA and the National Security Act. FEES Paper Documents and CDs Photocopies(5 free annually): pages,fee$ ($0.25/page) Laser printed pages: pages,fee$ ($0.10/page) Facsimile(max.5 pages) pages,fee$ ($1.00/page) Postage(certified mail) fee$ (actual cost) Electronic Documents Digital Image Conversion PDF document pages,fee$ ($0.10/page) Digital image from film pages,fee$ ($0.10/page) Digital image from microfiche pages,fee$ ($0.10/page) Medium of Delivery E-mail of PDF No charge(available only if document is fewer than 25 pages) 3.5"diskette or CD $3.50/disk,fee$ Audiotape $7.00/tape,fee$ Non-Incidental and Supervisory Services (15 minutes free weekly) minutes,fee$ ($3.75 to$6.00/15 minutes), initials of employee performing services Other Expenses Incurred: (description),fee$ TOTAL FEE:$ ,Paid On DOCUMENT MANAGEMENT SYSTEM USE REPORT The Document Management System was used by the above-named individual from o'clock_.m.to o'clock_.m.on ,20_ ACCEPTANCE&RECEIPT Documents were received and acknowledged on: Date Recipient's Full Name—Please Print Custodian's Signature Recipient's Signature Revised 12.16.08 4 •'' City of Riverdale,Iowa Records Request Form Name (Full Legal Name) Address Description of Records Requested: REQUEST ❑Request made in writing ❑Requesting ❑ Request made verbally ❑Email ❑Copies ❑Phone message ❑Facsimile ❑ View originals ❑Direct phone conversation ❑Postal mail ❑In-person ❑In-person Submitted on: (Date and Time) Request processed on: (Date and Time) Estimate of fees,if applicable: $ Advance deposit retained, if applicable: $ 10 Business Days from Request: (Date and Time) Note: A reasonable delay is permissible to determine if the record is a confidential record,but the delay shall not exceed twenty calendar days and ordinarily should not exceed ten business days. 20 Calendar Days for Submission: (Date and Time) Date on Which Legal Counsel's Opinion Sought: NOTIFICATION Notified that documents are ready for(select one) ❑pick-up at City Hall during posted hours, ❑pick-up at City Hall by appointment(date and time as listed below) ❑ examination of the original at City Hall during posted hours, ❑examination of the original at City Hall by appointment(date and time as listed below),or ❑documents will be mailed to the individual via certified mail at the individual's expense. 1. (Date)and (Time) ❑In-person❑phone message❑direct phone conversation❑email(check all that apply) 2. (Date)and (Time) ❑In-person❑phone message❑direct phone conversation ❑email(check all that apply) Notes or Special Requests: Appointments are available between 9:00 a.m.and 12:00 p.m.and 1:00 p.m.and 4:00 p.m.Monday through Friday,excluding legal holidays. A copy of the Fee Schedule,which outlines the fees applicable to public records requests,is available free of charge. Please note,original documents will be made available for review under the supervision of the custodian with the exception of documents that contain confidential information as provided by both federal and state law including but not limited to Iowa Code Section 22.7,HIPAA and the National Security Act. FEES Paper Documents and CDs Photocopies(5 free annually): pages,fee$ ($0.25/page) Laser printed pages: pages,fee$ ($0.10/page) Facsimile(max.5 pages) pages,fee$ ($1.00/page) Postage(certified mail) fee$ (actual cost) Electronic Documents Digital Image Conversion PDF document pages,fee$ ($0.10/page) Digital image from film pages,fee$ ($0.10/page) Digital image from microfiche pages,fee$ ($0.10/page) Medium of Delivery E-mail of PDF No charge(available only if document is fewer than 25 pages) 3.5"diskette or CD $3.50/disk,fee$ Audiotape $7.00/tape,fee$ Non-Incidental and Supervisory Services (15 minutes free weekly) minutes,fee$ ($3.75 to$6.00/15 minutes), initials of employee performing services Other Expenses Incurred: (description), fee$ TOTAL FEE: $ ,Paid On