HomeMy WebLinkAbout2012-249 S Mgr - Orange Co Rape Crisis Center $25,000 Pr
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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: Orange County Rape Crisis Center PartyNendor Contact Person: Shamecca Bryant Contact Phone:919-968-4647
PartyNendor Address: 1505 East Franklin STreet, Suite 302,PO Box 4722 City Chapel Hill State:NC Zip:27514 Department:
Outside Agency Amount:$25,000 Purpose:Outside Agency Budget Code(s): 10495050-710009 Vendor#800015 (N/A if new
vendor) Vendor is a BOCC consultant? Yes❑NoZ Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective
Date 07/01/2012 Approved by Board Yes No❑ Agenda Date:06/19/2012 Title of Contract:2012-13 Outside Agency
Performance Agreement
If this is a Grant Agreement,pre-application has •ee approved by the Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP n s r This contract has been reviewed and approved by the Department Director as to
technical content: L
Department Director' : gnature: �.,tlt/ -. Date: 2 --11,--1 L.
T Director
(Applicable only to ardware/software pure o es or r- • -d services)This contract has been reviewed and approved by the Information
Technology Director : • -chnical content and information technology specifications:
IT Director's Signature: Date:
Risk M nagement
Include the following coverages: dCGL; 'Auto; �WC; ['Professional; ❑ Property; ❑ OR No Insurance Required D. 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 Signature: t/l n,�
4"-i >� Ali— Date: 1(1 - (Z
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑Nod A budget amendment is necessary
before approval Yes❑No InY 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: C1 ._ .' i • A/1-4--- Date: u/7-111'
County Attorney
Approval by Board `j'r (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Manag- NI (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency: I P
Attorney's Signature �` i� : Z
y g \. Date. 3
County Manager
This contract has been reviewed and is approved by the County Manager Ye.sTallo0.
This contract has been reviewed and is to be submitted for BOCC consideration Yes[21Qo 0. �
Manager's Signature: , l , I / /0 Date: ^/ 169—/y
Cler. to the Board
Approved by BOCC on the day of ,21 . Submi d for Chair sign on the day of ,20 .
Clerk's Signature: / /, Date: ) 2�
Revised April 2010