HomeMy WebLinkAboutR 2013-210 Aging - Janice Gaalloway Fit Feet Nurse $8,000 ORANGE COUNTY—CONTRACT CONTROL SHEET
Routing Order: (7)Department,(Z)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 for8OCC approval. Contracts for
8OCC approval must be submitted tbnuo8k and complete,the routing process prior tn agenda review. Contracts for legal review should
beuwmp\etodtbrnughtbelogu{rcvimvvpn�oampr�rtoheiogr*�ed�rsignature.
Department
Partv'Vendor Name: Janice Galloway Party/Vendor Contact Person: Same Contact Phone.
. )_ Party/Vendor Address:6615 Glen
Forest Drive City Chapel Hill State:NC Zip: 27517 Department:Aging Amo $8 Purpose:Fit Feet Nurse Budget Code(s):
29430320-622000 Vendor# 58613- (K/—A if new vendor) Vendor is a BOCC Yes E]NoZ Contract Type:(Check one)
New M Renewal [9 Amendment n Effective Date July 1,2013 Approved by Board Yesn Non Agenda Date: Title of
Contract: Wellness Instructor
If this ioa(Grant Agreement,pre-application has been approved by the Board nf Commissioners YuonNon. lf submitted for bid were
bida/RFPa received YeuFlNoFl 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/o6u,dwuru6oftwore purchases o/related services)This contract has been reviewed and approved hy the Information
Technology Director usko technical content and information technology specifications:
IT Director's Signature: Date:
Risk Manaaement
|nc|ude the following coverages: Fl CGL; n Auto; Fl WC; n9rofeomkmo|; Fl Property; OR Hold
Contract pending receipt n[Certificate ofInsurance With incorporation of Insurance provisions as shown,this contract is approved
h) the Risk Manager:
Risk Manager's Signature: Dat : �
Z^s--^ L.I M
Financial Services
This Contract is conditioned qpon appropriation by the Board ofCommissioners `ycmnNo[z A budget amendment is necessary
before approval YeoD |No[7 1f budget amendment io necessary, please attach io this form. This instrument has been pre-audited bnthe
manner required hy the Local Government Budget and Fiscal Co l ct:
Financial Services Director's Signature: Date:
County Attorney
Approval by Board Fl (Contracts $00000 or more for goods or services, $250,000.00 or more for construction, or any DOCC
consultant ) ] . Department Director approval only[](Under
$}`OOO). This contract has bee eview approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: �
County Manne
[bix contract has been reviewed and is approved by the County Manager l'cvENoFl.
Tbiacontract Fl [:�,
Manager's Signature: Date: 7
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