HomeMy WebLinkAbout2012-256 S DEAPR-Andrew Wagoner for Tae-Kwon-Do Instruction $4,968 _)h --- St, 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
Party/Vendor Name: Andrew Wagoner Party/Vendor Contact Person: Andrew Wagoner Contact Phone:336-562-8007 Party/Vendor
Address:308 Dave Smith Road City Prospect Hill State:NC Zip:27314 Department:DEAPR Amount:$4968.00 Purpose:Tae-
Kwon-Do Instruction Budget Code(s):630000 Vendor if 56749 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No
Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective Date July 6,2012 Approved by Board Yes❑No
Agenda Date: Title of Contract:
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. 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 Signature: IV Date: 7 1 13/12.
IT Director
(App able illy to hardivare/software purchases or related services)This contract has been reviewed and approved by the Information
Tecimo 'Director as to technical content and information technology specifications:
IT Dir ctor Signature: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; 0 Professional; ❑ Property; ❑ OR No Insurance Required ri. Hold
Contract pending receipt of Certificate of Insurance O. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: y /�
Risk Manager's Signature: 0�� -'tN +V i ,/4- Date: VUtt Z
. 11 t`)I L
• Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[ A budget amendment is necessary
before approval Yes❑NoIlf 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:
et
Financial Services Director's Signature: "�a",.`....., A Date: 7f 24/1( Z
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 4 (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Date: 7 T
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 submitted or B•ACC consideration Yes❑No
Manager's Signature: i' ' Date ' ' 1
lerk to the Board
Approved by BOCC on the day of ,20 . Submitted for Chair signature on the_day of ,20 .
Clerk's Signature: Date:
Revised April 2010