HomeMy WebLinkAboutR 2013-026 Health - Nick Fitzgerald East Chapel Hill High School TRU Club Advisor $500 ORANGE COUNTY—CONTRACT CONTROL SHEET
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Routing Order: (}) Department,(2)IT,(3)Risk Management,(4)Financial Services, (5)Attorney, (6)Manager,(7)Clerk
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This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. |[the Manager
determines the contract ix not appropriate for Manager approval the Manager shall submit the contract for BOCCapproval. 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: Nick Fitzgerald. Party/Vendor Contact Person: Nick Fitzgerald. Contact Phone: (919) Pbl'-�482 x 241.
Party/Vendor Address: 115 Pointe Place. City Hillsborough. State: NC Zip: 27278 Department: Health Amount: �00 P*pose: East
Chapel Hill High School TRU Club Advisor Budget Code(s): 10412020—630000 Vendor# 58401 (N/A if new Vendor is a
BOCC consultant? YesE]NoZ Contract Type: (Check one)New R Renewal E Amendment 0 Effective ate July 1,2012.
If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Yes—_No f submitted for bid
were bido/RFPu received ycmR l4oR. Bid/KFP number This contract has been reviewed and approved by the Department
Director ustotechnical content:
Department Director's Signature: Date:
W eirector
(Applicable onh;m6oruwm,elsoftwuro purchases or related xnr~icur)This contract has been reviewed and approved by the Information
Technology Director as to technical content and information technology specifications:
l3Director's Signature: Date
Risk Management
Include the following coverages: E] CGL; R Auto; E] WC; R Professional; El Property; El OR No Insurance Required E2/ 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: 4�� 44v_. Date: I bqo
Financial Services
This Contract is conditioned tjpon appropriation by the Board of Commissioners YesRNoR( A budget amendment is necessary
before approval Yeso Noff 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: Date:
County Attorney
Approval by Board R (Contracts over $25,000.00 or any BOCC consultant contract). Approval by Manager 0 (All contracts
$25,000.00 or less with the exception of BOCC consultants). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Date:
County Manaze
This contract has been reviewed and is approved by the County Manager YesR No[].
This contract has been reviewed and is to consideration YesRNoE].
Manager's Signature: Dat
Qerk to the Board
Approved by Board YesF]NoE] Agend/ate:
Clerk's Signatare: Date: