HomeMy WebLinkAbout2012-048 Aging - Johnnie Belk $1,000+ � 1 NGE C iT C NTR CT; C NT . SHEET
Routing Order: l Department, IT, Risk Management, Financial Services, Attorney, Manager, 7 Clerk
This Document shall accompany all eontracts and shall be submitted for signature in the Routing Order specified above. If the Manager
determines the contract is not appropriate for Manager approval the Manager shall submit the contract for B CC approval. Contracts for
B CC approval must be submitted through, and complete, the routing process prior to agenda review. Contracts for legal review should
be completed through the legal review process prior to being routed for signature.
Department
Party /Vendor Narne: Johnnie Belli Party/ Vendor Contact Person: Contact Phone: PartyNendor Address: 1011 Castor
Ave City Durham State: NC Zip; 27707 Department- Aging AMOLint: $1,000.00 purpose: activity instructor Budget Code(s) :
10432020- 630102 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant ` YYes El NoZ Contract Type: (Check oil e)
New M Renewal ❑ Amendment ❑ Effective Date 03701/12 Approved by Board Yes❑ No❑ Agenda Date: Title of
Contract: Senior Center Instructor
If this is a Grant Agreement, pre - application has been approved by the Board of Commissioners Yes[:] No❑. If submitted for bid were
bids R l s received Yes❑ No❑ id RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date:
IT Director
(Applicable on ly to hardwarelsoftware purc h s or related services) This contract has been reviewed and approved by the Inf rmation
Technology Director as to technical content and information technology specifications:
IT Director's Signature.
Date:
Disk Man ernent
Include the following coverages: ❑ C L; ❑ Auto; ❑ WC; ❑ Professional; [:] Property; � No Insurance Required ❑. Mold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Kish Manager's Signature: 4-ol Date: 2-, Z�5 f �
Financial Services
This Contract is condition d upon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary
before approval Yes❑ No W. If b ` udget amendment is necessary, please attach to this form. This instrument has been pre- audited in the
manner required by the Local Govemment Budget and Fiscal Control Act:
Financial Services Director's Signatur e. Date: 2`w► 2 �, )L
County Attorn
Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Manager (All other contracts). This contract has been reviewed and approved by the Attonley as to legal
form and sufficiency:
Attorney's Signature Date: �z azc
County Manager
This contract has been reviewed and is approved by the County Manager Yep No ❑.
This contract has been reviewed and is to be submitted for BCC consideration Yes ❑On.
f� Ifr I
Manager's Si nature: t Date:
Clerk to the Board
Approved by BCC on the clay of , 20 Submitted for Clair signature on the day of , 2
Clerk's Sigtta ure. Date. 2�,
UU
Revised April 2010