HomeMy WebLinkAbout2012-318 CNS Mgr - El Centro Hispano Out Side Agency $17,000 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: El Centro Hispano Party/Vendor Contact Person: Pilar Rocha-Goldberg Contact Phone:919-687-4635
Party/Vendor Address:600 East Main Street City Durham State:NC Zip:27001 Department: Outside Agency Amount: $17,000
Purpose:Outside Agency Budget Code(s): 10495050-719058 Vendor#801399 (N/A if new vendor) Vendor is a BOCC consultant?
Yes❑NoZ Contract Type: (Check one)New 23 Renewal❑ Amendment ❑ Effective Date 07/01/2012 Approved by Board Yes
ED No❑ Agenda Date:06/19/2012 Title of Contract:2012-12 Outside Agency Performance Agreement
If this is a Grant Agreement,pre-application has been ap
proved by the Board of Commissioners YesF]No❑. If submitted for bid were
This
bids/RFPs received Yes❑NoF] Bid/RFP nurn r s contract has been reviewed and approved by the Department Director as to
technical content: Bid/RFP This contract has been
Department Director's Signature: — Date:
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Direc r
(Applicable only to hardwarelso rchases or relate ervices)This c ct has been reviewed and approved by the Information
!f;:
Technology Director as to technical content and information technology specifications:
IT Director's Signature: Date:
Risk Mataiientent
Include the following coverages: 12(CGL; [Auto; [WC; [4 Professional; ❑ Property; ❑ OR No Insurance Required El. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature:A44,t., J/U-j Date: 241
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners YesE]No[E/ A budget amendment is necessary
. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
before approval YesE]NoV
manner required by the Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature: _Date:__9LZ4
County Attornev
Approval by Board A(Contracts over $90,000.00 for goods or services, $250,000-00 for construction, or any BOCC consultant
contract). Approval by Mana e ❑ (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Date: IL
County Manaeerl
This contract has been reviewed and is approved by the County Manager Yes 23-Nrn.
This contract has been reviewed and is considers iRonVesQNOFT
Manager's Signature: Date:`
—Clerk 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