HomeMy WebLinkAbout2012-250 S Mgr - Planned Parenthood of Central NC $20,000 ORANGE COUNTY—CONTRACT CONTROL SHEET
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.
Department
PartyNendor Name: Planned Parenthood of Central NC PartyNendor Contact Person: Elizabeth Irwin Contact Phone:919-929-5402
PartyNendor Address: 1765 Dobbins Drive,PO Box 3258 City Chapel Hill State:NC Zip:27514 Department:Outside Agency
Amount:$20,000 Purpose:Outside Agency Budget Code(s): 10495050-710013 Vendor#800040 (N/A if new vendor) Vendor is a
BOCC consultant? Yes 0 No Contract Type:(Check one)New El Renewal 0 Amendment El Effective Date 07/01/2012
Approved by Board YesEj No0 Agenda Date:06/ 9/2012 Title of Contract:2012-13 Outside Agency Performance Agreement
If this is a Grant Agreement,pre-application has b en a,proved by the Board of Commissioners Yes0 No0. If submitted for bid were
bids/RFPs received Yes0 No0 Bid/RFP / rn This contract has been reviewed and approved by the Department Director as to
technical content:
Allig Ilk
( Wil
Department Director's Sign: re: AMMON'CAN A Date: 7— it — / •
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vir,
11 II ector
(Applicable only to hardware/software 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: [ "CGL; E2 Auto; WC; [ 'Professional; 0 Property; 0 OR No Insurance Required 0. Hold
Contract pending receipt of Certificate of Insurance [ . With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: U-11"4-' A , i.---- Date: 1(14 17-
Financial Services
This Contract is conditioned 9pon appropriation by the Board of Commissioners Yes0No[Yr A budget amendment is necessary
before approval Yes[]No If budget amendment is necessary, please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature: etee-4 4_‘......- .i. jitic-/' Date: 171 I z-I r9--
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 Manager CI (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
11 Date: 1
Attorney's Signature ill -PA
County Manager
This contract has been reviewed and is approved by the County Manager YesL:g-No[ ].
This contract has been reviewed and is to be submitted for BOCC cons'i tion Yes12Mo0.
Manager's Signature: #
1 , 1 0/ /
Date: 7--(6, /Z--
Clerk to t e Board
Approved by BOCC on the day of Submitted for Chair signatik4
l e day of ,20 .
i ar
Clerk's Signature: Date: 1 7/'7//\._
Revised April 2010