HomeMy WebLinkAbout2012-189 S Aging - Charles House Association $3,000. , ,,/,4 /6'
ORANGE COUNTY—CONTRACT CONTROL SHEET
Routing Order: (l)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager (7)Clerk
This Document shall accompany all contracts 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 BOCC approval. Contracts for
BOCC 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 Name: Charles House Association Party/Vendor Contact Person: Puu|K\cvcr Contact Phone: PurtyNcudor
Address: 109 Hillcrest Ave. City Carrboro State:NC Zip: 27510 Department: Aging Amount: $3,000.00 Purpose: Community Respite
Services for A iu Transitions Budget Code(s): 10432020-630102 \/cndor# }V446 (N/A if new vendor) Vendor is a BOCC
consultant? Yes oFl Contract Type: (Check one)New fl Renewal[Z] Amendment 0 Effective Date U7/Ol/2O)2 Approved by
Board Yev0No0 Agenda Date: Title of Contract:
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Ycx0 No0. If submitted for bid were
bida/KFPo received TesFlNu0 Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
8�epu,tmuemt|Nir*cumr"oSignature: C)a...i.i.... - _� D�c: L«/�[a/ /�_'' � 1 �- ' '
IT Director
(Applicable only to purchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to technical content and information technology specifications:
IT Director's Signature: Date:
Risk Management
Include the following coverages: 0 CGL; 0 Auto; Fl WC; g~irob:smionu|; 0 Property; OR No Insurance Required 0. Hold
Contract pending receipt of Certificate of Insurance LI. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk MmomKwr`uSkAumtmrw:
---P / � �' ' u� Date: y~ ��P'/��
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Financial Services
This is dii appropriation by the Board of C i i Yeu0N A budget amendment is necessary
before approval Yen|| If budget amendment is necessary,please attach to this form. hi. instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal C l Act:
Financial 8orviceo|�irectwr,mSignature: �4 �m�~�~� ��. Jk1__— Date ')-
�
~p.e��. ��)��, � ,
County Attorney
Approval by Board [l (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manag st other contracts$1,000 and above). Department Director approval only El (Under
$1,000). This contract h bee viewed uoduppnuvedhydhc/\uocucyaxu, |cgu| 1oonundxufficicuuy:
�
Attorney's Signature Date: «/= �«-~
~ County Manager
This contract has been reviewed and is approved by the County Manager YegrfNoFl.
This contract has been reviewed and is for ' uuu A.y t 2,uir },es0Nog!
I � � ����moogmr^oSigoatnre� ' ° -�� Date:
� ' � --
Signature: 11.
Clerk to the Board
f\pp,ovudhyB0CC"od`cdoyof . 20 . Submitted for Chair signature on the day of . 20 .
Clerk's Signature: Date:
Revised March 2012