HomeMy WebLinkAbout2012-254 S Aging - Vibeke Talley for Occupational Therapy Services $1,400 - .~
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ORANGE K�K�NTROL SHEET
Routing Order: (1)D t,(2)l][(3)R6okMuougemout,(4)FiouooialServiceo'(5)Attorney.(6)Mymugnr (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
Party/Vendor Name: Vibeke Talley Party/Vendor Contact Person: same Contact Phone: PuctyNcudor&ddrosu: 134 E Tryon
Street City Hillsborough State:NC Zip:27278 Department:Aging Amount: $1,400.00 Purpose: Occupational Therapy Services
Budget Code(s): 10432020-630103 Vendor#398 if new vendor) Vendor is a BOCC consultant? Yes No Contract
Type: (Check one)New[E] Renewal El Amendment 0 Effective Date O7/l6/2Ol2 Approved by Board Ycv||No Agenda
Date: Title of Contract: Eldercare-OT Provider
If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Yoo0No0. If submitted for bid were
bido/REPo received YcoFlNo[l Bid/RFpoumber This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: xy Date: 7-11-12
IT Director
(Applicable only m6on6vu,u/softvunc purchases or related services)This contract has been reviewed and approved hy the Information
Technology Director as to technical content and information technology specifications:
IT Director's Signature: Date:
Risk Management
Include the following coverages: CGL; 0 Auto; LlwC; El Professional; Property; OR No Insurance Required Hold
Contract pending receipt of Certificate of Insurance 0. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk �
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Financial Services
This Contract is conditionecon appropriation hydhcBomdofCoo,miaaionero Yua0NoEt< A budget amendment is necessary
before approval YesEl NoM. If budget umcodmcntianeceeeary. please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Con Act:
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F�xuncimlServices 0^kmoomwr`mSignature: 14"4".44/ Date:D �� ^it��/ i2-
County Attorney
Approval by Board Ej (Contracts $90,800.00 or more for goods or services, $250,000.00 or more for construc\\on, or any BOCC
consultant contract). Approval by Manager (Most other contracts$1,000 and above). Department Director approval only El (Under
$1.000). This contract has b reviewed and approved by the Attorney as to legal form and sufficiency:
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Attorney's Signature
Date: 7/2 7�r2
County Manager
This contract has been reviewed and is approved by the County M NoEj.
This contract has been reviewed and is for s - . esLJNoa.
0 I r�� I
• 7/Z Z 7,/
Manager's Signature: Date:
Clerk to the Board
Approved by BOCC on the day of ,20 . 8"bmiocdto,Cbuirsigomu,coutbcduyn{ .20
Clerk's �
0i�mmtomu� Date:
Revised March 2012