HomeMy WebLinkAboutR 2013-099 Aging - UNC for Occupational Therapist Contract Services $7,000 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.
Party/Vendor Name: Universi of Department
Party/Vendor Address:De to led He 0011 e es d f lilt Party/Vendor
Ha1�CB#712 Contact ty Person:
el enni er Womack Contact Phone:
Department:Agin Amo 7 000 ose:O. ccupational Therapist contract services Budget Code(s): 10432020-630 03 Vendor#
10419 (N/A if new vendor '–�
or is a BOCC consultant? Yes[]No® Contract Type:(Check one)New❑ Renewal
Amendment ❑ Effective Da a December 1 2012 Approved by Board Yes No
Independent Contracor Agreement ❑ ® Agenda Date: Title of Contract:
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes[]Non. If submitted for bid were
bidSIRFPS received Yes❑Non BidIRFP number This contract has been reviewed and approved by the Department Director as to
technical content:
_Want Director's Signature: Date:
Er Director
(Applicable only to hardwarelsoftware 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 Ma a ement
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; EO Professional; ❑ Property; OR No Insurance Required M. Hold
Contract pending receipt of Certificate of Insurance M. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date: t 1
Financial Services
This Contract is conditioned ijpon appropriation by the Board of Commissioners Yes❑No[( A budget amendment is necessary
before approval Yes❑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: aL—t-1 A 'All(—— Date:
County Attorney
Approval by Board ❑ (Contracts $90,000.00 o more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Managerost other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has been r viewed at oved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: : 2.2-13
County Manager
This contract has been reviewed and is approved by the County Manager Ye ' No❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑- /
Manager's Signature: 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