HomeMy WebLinkAbout2012-315 Aging - Senior Caare of Orange Co Inc Community Respite Services for Aging Transition $4,000 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: Senior Care of Orange ty,Inc. Party/Vendor Contact Person: Alvonia Baldwin Contact Phone: 919-245-
2017 Party/Vendor Address: 105 Meadowlands Drive City Hillsborough State:NC Zip:27278 Department:Aging Amount:
$4,000.00 Purpose: Community Respite Services for Aging Transitions Budget Code(s): 10432020-630105 Vendor#52717 (N/A if
new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check one)New❑ Renewal® Amendment ❑
Effective Date 08/15/12 Approved by Board Yes❑No® Agenda Date: Title of Contract:Respite Care
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: Date: /O-/L
IT Director
(Applicable only to hardwarelsoftware 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 Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required T/Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: (j
Risk Manager's Signature: C t_1 �. Date: D l2
Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No� A budget amendment is necessary
before approval Yes[:]NoF If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Bud a and Fiscal Control Act: p�
Financial Services Director's Signature: N� o Date: 12'
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 contract has been viewed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: Z-
County Manager
This contract has been reviewed and is approved by th County Manager Yeso No❑.
This contract has been reviewed and is for sig ature e Chair Yes❑No
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 March 2012