HomeMy WebLinkAboutR 2013-058 DSS-Dispute Settlement Center $10,000 a
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: Dispute Settlement Center PartyNendor Contact Person: Francis R6_nde_r n Contact Phone: Party/Vendor
Address:— City— State:_ Zip:_ Department: Amount: 0 000 ose:_ Budget Code(s):
Vendor#_ (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No 1C. ct Type:(Check one)New ❑ Renewal
❑ Amendment r_1 Effective Date_ Approved by Board Yes❑No Agdh7a 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 YesFl No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature:1 rk-,, C4W4, pq-,-A- 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 Magagement
Include the following coverages: � CGL; d Auto; R WC; 0 Professional; ❑ Property; OR No Insurance Required Fl. Hold
Contract pending receipt of Certificate of Insurance Fl. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature:-.... Date: 2-11-13
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[E'.'* A budget amendment is necessary
before approval YesD 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:
Financial Services Director's Signature: .4 AV— Date:
County Attorney
Approval by Board E] (Contracts $90,O)V. 0more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approva anagt (Most other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has bee rev wed d+oved by the Attorney as to legal form and sufficlencyl
Attorney's Signature Date: 17S
County Manazer
0,
by the County lAanager e 3.
0
This contract has been reviewed and is for si CSEI'NV
This contract has been reviewed and is approved
Manager's Signature: Tv;r Date:
LI/
Clerk to the Board
Approved by BOCC on the day of Submitted for Chair signature on the day of 20
Clerk's Signature: Date:
Revised March 2012