HomeMy WebLinkAbout2012-319 S Health - Diana Montgomery Community Organizer/Interagency Liiaison $ 4,500 ZOLA- 25 1°i
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: Diana Montgomery Party/Vendor Contact Person: SAME Contact Phone:919- Party/Vendor Address: 1830
Halls Mill Rd.,Efland NC 27243 City Hillsborough State:NC Zip:27278 Department: Health Amount:$4,500 Purpose: Community
Organizer/Interagency Liaison Budget Code(s): Vendor#61441 (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❑
No❑ 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❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date:83.
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 Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required [d Hold
Contract pending receipt of Certificate of Insurance M. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: v��^�^ `"` Date: D 12
Financial Services
This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑Nog. 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:
Financi al Services Director's Signature: �. Date: 2
County Attornev
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 be eview a approved by the Attorney as to legal form and su fic' ncy
Attorney's Signature Date: ? 24 f&
County Manager
This contract has been reviewed and is approved b the Co ty Manager Yes�No❑.
This contract has been reviewed and is far, a re y air Yes❑Noa.
Manager's Signature: Date: _ Z f
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