HomeMy WebLinkAbout2012-126 S Housing - Habitat for Humanity FY 2011 HOME Program $175,000 ORANGE COUNTY—CONTRACT CONTROL SHEET �( d
"'( �? -`'outing 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.
Department
PartyNendor Name: Habitat for Humanity PartyNendor Contact Person: Susan Levy Contact Phone:919-932-7077 PartyNendor
Address: 88 Vilcom Center Drive City Chapel Hill State:NC Zip:27514 Department: Housing/Human Rights and Community
Development Amount: $175,000 Purpose:FY 2011 HOME Program Budget Code(s): 32473005 Vendor# (N/A if new vendor)
Vendor is a BOCC consultant? Yes❑No11 Contract Type:(Check one)New❑ Renewal❑ Amendment 1 Effective Date
04/24/12 Approved by Board Yes It No❑ Agenda Date:05/03/2011 Title of Contract: Development Agreement Amendment
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑Non. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content: /
Department Director's Signatu�•: Z. „MO �� Date:
*5/7*
ir
IT or
(Applicable only to hardware/software purchases or related servic ontract has been reviewed and approved by the Information
Technology Director as to technical content and information tech ology specifications:
IT Director's Signature: Date:
��c3e
Risk 4ana. m•ntT *c.
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ ''fessional; ❑ Property; ❑ OR No Insurance Required O. Hold
Contract pending receipt of Certificate of Insurance El. With in erpor• '•n of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date:
Financial Services,
This Contract is conditione pon appropriation by the Board of Commissioners YesENo A budget amendment is necessary
before approval Yes❑No If budget amendment is necessary,please attach to this form. i instrument has been pre-audited in the
manner required by the Local Government Bud et d Fiscal Control Act:
Financial Services Director's Signature:
Date: S 13 l(/2--
County Attorney
Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by M. •=er V:t `• II other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
WAIL. Date: I 2 Attorneys Signature ��
County Manager
This contract has been reviewed and is approved by the County Manager Ye No❑.
This contract has been reviewed and is to be su emitted for 'O C conside tion Yes❑ .
Manager's Signature: I I Date: . I —/ v
to the Board
I
Approved by BOCC on the'day of 20 /I . Submitted for Chair signature on the_day of 1 ,20 .
Clerk's Signature:
/ Date: U ( `A k L
J )
Revised April 2010