HomeMy WebLinkAbout2012-309 S Health - Pascale Mittendorf for Community Organizer/Interagency Liaison $4,500 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: Pascale Mittendorf Party/Vendor Contact Person: SAME Contact Phone:919- Party/Vendor Address: 1 Winnawa
Walk,Hillsborough,NC 27278 City Hillsborough State:NC Zip:27278 Department: Health Amount:$4,500 Purpose: Community
Organizer/Interagency Liaison Budget Code(s): Vendor#61440 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑
No[] Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective Date August 1,2012 Approved by Board Yes❑
Non Agenda Date: Title of Contract:COIL-Community Organizer/Interagency Liaison
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❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content: ����`'^r-- �!'�.--
Department Director's Signature: Date: ri I jot
IT Director
(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 Manaeement
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required 1W. Hold
Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
_Risk Manager's Signature: ff Aw-'~ Date: 4 Z
4'kz�- 1EM al 1?t
Financial Services
This Contract is conditioned ullon appropriation by the Board of Commissioners Yes❑No[R./ 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: 4,-, � /�� Date:
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contraci has e n rev' ed and approved by the Attorney as to legal form and suffici ncy:
Attorney's Signature Date: {IL
County Manager
This contract has been reviewed and is approved by the County Manager Yes'CNo❑.
This contract has been reviewed and is for signature by the Chair Yes❑NoL;-'
Manager's Signature: _ Date:
Clerk to the Board
Approved by BOCC on the_day of 20 Submitted for Chair signature on the_day of 120
Clerk's Signature: Date:
Revised March 2012