HomeMy WebLinkAbout2012-240 S Mgr - Habitat for Humanity of Orange Co $10,000 „c7,f»._;;_ es()
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: Habitat for Humanity of Orange County,NC PartyNendor Contact Person: Susan Levy Contact Phone:919-932-
7077 PartyNendor Address: 88 Vilcom Center Drive City Chapel Hill State:NC Zip: 27514 Department: Outside Agency Amount:
$10,000 Purpose:Outside Agency Budget Code(s): 10495050-710023 Vendor#800020 (N/A if new vendor) Vendor is a BOCC
consultant? Yes CI No Contract Type:(Check one)New E Renewal CI Amendment 0 Effective Date 07/01/2012 Approved by
Board Yes[X]NoD Agenda Date:06/19/2012 Title of Contract:2012-13 Outside Agency Performance Agreement
If this is a Grant Agreement,pre-application has bee, approved by the Board of Commissioners YesD No0. If submitted for bid were
bids/RFPs received Yes[I]NoD Bid/RFP nu/her his contract has been reviewed and approved by the Department Director as to
technical content: ....—
401/214-01,
Department Director's Sign.ture: Aral Y4*A t)
■ — Date: 7e” 11 "I 2 --
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IT Di ctor
(Applicable only to hardware/software purchases or relat.: :- . ces)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 M3nagement
Include the following coverages: N/j/CGL; 2/Auto; 'WC; 111UProfessiona1; El Property; El OR No Insurance Required 0. Hold
Contract pending receipt of Certificate of Insurance EUe With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: alci..,,,... 2' A...,_ Date: rillq,z,
Financial Services
This Contract is conditioned u appropriation by the Board of Commissioners Yes0NoW 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: tv.44./
1,16/ 11/' Date: lii et/4.
County Attorney
Approval by Board 0 (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Mani,-r 0 (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature / 00. Date: ES
County Mana!er
This contract has been reviewed and is approved by the County Manager YcsIETNo0.
This contract has been reviewed and is to be submitted for BOCC consideration Yel/NloD.
Manager's Signature: DA0 i I Date: ? —(& / Z
.lerk to the Board
Approved by BOCC on the day of 411,w,, . • bmitted for Chair siature19.on the day/of ,20 .
mit
Clerk's Signature: T I 6 Date:
Revised April 2010
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