HomeMy WebLinkAboutR 2013-178 Aging - Charles House Association for Caregiver Respite $10,000 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: Party/Vendor
Address: 109 Hillcrest Ave. City Carrboro State:NC Zip: 27510 Department: Aging Amount: $10,000 Purpose:Caregiver Respite
Budget Code(s): 10432020-630105 Vendor# 19446 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract
Type:(Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/2013 Approved by Board Yes❑No❑ Agenda
Date: Title of Contract:Respite Care Provider
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:
Department Director's Signature: 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 Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required [►e. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: fl,
Risk Manager's Signature: t/� � A /d'N� Date:
Financial Services
This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑No[R"* A budget amendment is necessary
before approval Yes❑No[y. 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 ContrA l Act:
Financial Services Director's Signature: t/t- �`- )/-w— Date: 4 ,5-13
County Attorney
Approval by Board ❑ (Contracts $90,000. or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approv y Manager (Most other contracts$1,000 and above). Department Director approval only El (Under
$1,000). This contract has b en evie approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: 6
County Manager
This contract has been reviewed and is approved by the County Manager Y N ]
This contract has been reviewed and iUsig y Chair Yes❑N
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