HomeMy WebLinkAbout2012-399 S DEAPR - Steve Kim for Tea Kwon Do Instruction $750 ORANGE COUNTY—CONTRACT CONTROL SHEET
Routing Order: (I)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,(lie 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: Steve Kim Party[Vendor Contact Person: Steve Kim Contact Phone:919 730-3697 Party[Vendor Address:4416
Still Valley Drive City Durham State:NC Zip:27707 Department:DEAPR Amount: 5750 Purpose:Tae Kwon Do Instruction
Budget Code(s):630000 Vendor 9 Mg (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check
one)New® Renewal❑ Amendment ❑ Effective Date November 1.2012 Approved by Board Yes❑Nolo Agenda Date:
Title of Contract:Tae Kwon Do Instruction.
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: D
Department Director's Signature: Date: I 1 bg 112-
IT Director
(Applicable only to haj dwaf e/softivare purchases or related services)This contract has been reviewed and approved by the information
Technology Director as to technical content and infornation technology specifications:
IT Director's Signature: Date:
Risk Management �,/
Include the following coverages: ❑ CGL; E] Auto; E] WC; E] Professional; E] L .Property; OR No Insurance Required Hold
Contract pending receipt of Certificate of Insurance❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: i
Risk Manager's Signature: v���- J� �`�� Date:41
1 12
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[9. A budget amendment is necessary
before approval Yes❑No(�if budget amendment is necessary,please attach to this fora. This instrument has been pre-audited in the
manner required by the Local Government Bucigel and Fiscal Conti I Act:
Financial Services Director's Signature: "t"� , Date: I l l Z
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 n(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:
County Manager
This contract has been reviewed and is approved by file County Manager YesD'No❑.
This contract has been reviewed and is for signs a by the C it s❑No��
Manager's Signature: Date:
C�kOi 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