HomeMy WebLinkAbout2012-195 S DSS-Charles House Associates for Home Services $25,000 ^
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ORANGE COUNTY—CONTRACT CONTROL Zr�
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Routing Order: (1)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.
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Party/Vendor Name: Charles 1-louse Association Party/Vendor Contact Person: Paul Klever Contact Phone: 919-967-7570
Party/Vendor Address: 109 Hillcrest Ave City Carrboro State: NC Zip: 27510 Department: DSS Amount: not to exceed$25,000
Purpose: In Home i Budget Code(s): 10400220'630000 Vendor# if new vendor) Vendor is a BOCC consultant?
Yes oll] Contract Type: (Check one)New fl Renewal N Amendment 0 Effective Date 07/01/12 Approved by Board Yes
0Nu0 Agenda Date: 06/15/12 Title of Contract:Charles House Association
If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners YeopNo0. If submitted for bid were
hido/RFPo received`yeo[] No0Bid/RFPnumber This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date: nL`-.)-Cl-/)--
IT Director
(Applicable only to hardware/software purchases s related 'rvices)This contract has been reviewed and approved by the Information
Technology Director as to technical content and info .t.: technology specifications:
iT Director's Signature: Date:
Risk Management
Include the following coverages: [a'CGL; g' Auto; &VVC; 2/Professional; Ei Property; OR No Insurance Required 0. Hold
Contract pending receipt of Certificate of Insurance Er. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's 8igoature� 1.4....4.4.- 1). D��� ^�/ %��/ 1�-� ', Date: . � �� �
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Financial Services
This Co is dhi Yos[�N & h��, umeudmemixn�o ��
before approval `/esLJ wo��. If budget amendment is necessary, please attach to this form. Th s instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Cuotru|Act:
Financial Services Director's Signature: /�' P^ Date: 7( 9[ /1--,t
County Attorney
Approval by Board El (Contracts $90,000.00 or more for goods or services, $250,000.00 or mor for construction, or any BOCC
consultant contract). Approval •y Manager other contracts$1,000 and above). Department Director approval only 0 (Undc,
$).0OU)� Tbiocou�uo�baoh� vicwc" �nd d by the Attorney as to legal form and sufficiency:
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Attorney's Signature
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Attorney's
County Manager
This contract has been reviewed and is approved by the County Manager Yee nZ].
This contract has been reviewed and is for signat b the Chair YemENu ."
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Manager's Signature: it - - Date: ` ~-
Clerk to the Board
Approved by BOCC on the day of ,20 . Submitted for Chair signature on the day of ,20 .
Clerk's Signature: Date:
Revised March 2012