HomeMy WebLinkAbout2012-378 S Mgr - Charles House Association Outside Agency $12,000 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: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone:919-967-7570
Party/Vendor Address: 109 Hillcrest Ave City Carrboro State:NC Zip:27510 Department:Outside Agency Amount: $12,000
Purpose:Outside Agency Budget Code(s): 10495050-710029 Vendor#800031 (N/A if new vendor) Vendor is a BOCC consultant?
Yes❑No[D Contract Type:(Check one)New Z Renewal❑ Amendment ❑ Effective Date 07/01/2012 Approved by Board Yes
Z No❑ Agenda Date:06/19/2012 Title of Contract:2012-13 Outside Agency Performance Agreement
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑Non. If submitted for bid were
bids/RFPs received Yes❑Non Bid/RFP number This ontract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: 0 F Datl'9—41.12
_Di ct
77
(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 Manazement
Include the following coverages: EYCGL; [J Auto; ; [professional; 2 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: Date: ( h tt?-
Financial Services
This Contract is conditioned vf)on appropriation by the Board of Commissioners YesE]Noo/ A budget amendment is necessary
before approval YesEl [I. 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:_ya^z, ,/� A_,� Date:
County Attorney
Approval by Board [t (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Manager ❑ (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature&at Date:
County Manager
This contract has been reviewed and is approved by the County Manager Yes OF1
This contract has been reviewed and is to be submitted for BP C consideration Ye'NoR.
Manager's Signature: VI
Date:
CIrk to the Board
Approved by BOCC on the day of 120 Submitted for Chair signature on the day of 120
"F'v'
Clerk's lerk's Signature: Date:
Revised evised April 2010