HomeMy WebLinkAbout2012-323 S Health - Kevin Kirk for Teach Exercise Component of Group Instruction $600 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: Kevin Kirk Party/Vendor Contact Person: Kevin Kirk Contact Phone: Party/Vendor Address:5311
Beaumons Dr. City Durham State:NC Zip:27707 Department: Health Amount: $600.00 Purpose: Teach Exercise Component of
Group Instruction for DSME Program Budget Code(s): 30412020 630000 71105 Vendor#34783 (N/A if new vendor) Vendor is a
BOCC consultant? Yes F-1 NoZ Contract Type: (Check one)New F-1 Renewal Z Amendment ❑ Effective Date July 1,2012
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: Date:
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; F-1 WC; r_1 Professional; ❑ Property; OR No Insurance Required e 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: Date: 24/12-
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This Contract is conditioned Financial Services 12(
conditioned appropriation by the Board of Commissioners Yes[jNo A budget amendment is necessary
before approval Yes❑No[V1. 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: d6v�� A. A114— '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). roy by Manager[(Most Most other contracts$1,000 and above). Department ❑Director approval only F I (Under
t has
$1,000). This contract rev and approved by the Attorney as to legal form and sufficl cy:
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Attorney's Signature Date: r_4 r
County Manner
This contract has been reviewed and is approved by the County Manager YqsFfNof_1.
This contract has been reviewed and is YesE]NpE;J�.
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Manager's Signature: 34 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