HomeMy WebLinkAboutR 2013-212 Aging - Martha Broda for Instructor $3,000 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
Partv'Vendor Name: Martha Broda Party/Vendor Contact Person: _' - Contact ho Party[Vendor Address: 1388 Mantis
_s
Chapel Road City Pittsboro State:NC Zip:27312 Departmen `Ain mount:t J=00(P0).0.V urpose: Instructor Budget Code(s):
❑NoZ Contract Type:(Check one)
29430320-630000 Vendor#58627 (N/A if new vendor) Ve=ia�OCC q
,6as�t? Yes r
New❑ Renewal 0 Amendment ❑ Effective Date July 1,2013 Approved by Board Yes❑Non Agenda Date: Title of
Contract: Wellness Instructor
If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Y esn No❑ If submitted for bid were
bids/RFPs received Yes❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: QA.4�4 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 12/• Hold
Contract pending receipt of Certificate of Insurance n. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: aa�, 4t AA/" Date:
LP 1 zz
Financial Services
This Contract is conditioned 4pon appropriation by the Board of Commissioners YesFINo[E. A budget amendment is necessary
before approval Yesn Nog. 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:A�414,4,_- A A., Date: ',I/,
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 o- more for construction, or any BOCC
consultant contract). Approval by Manager` (Most other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has roved by the Attorney as to legal form and suffic
Attorney's Signature Date:—,(ency:
County Manager
This contract has been reviewed and is approved by the County Manager YesPi'N4o❑.
I-his contract has been reviewed and is for sigriatur Yes❑NoL?.
Manager's Signature: Date.i
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