HomeMy WebLinkAboutR 2013-208 Aging - Kevin Kirk for Instructor $10,000 00 11E�— 117�
ORANGE COUNTY—CONTRACT CONTROL SHEET
Routing Order: (l)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: Kevin Kirk Party/Vendor Contact Person: same Contact Phone.. PartyNendor Address:5311 Beaumont
Drive City Durham State:NC Zip: 27707 Department:Aging Amount: $ 0 000.0 ose: Instructor Budget Code(s):29430320-
630000 Vendor#34783 (N/A if new vendor) Vendor is a BOCC cons es❑No® Contract Type:(Check one)New❑
Renewal ® Amendment ❑ Effective Date July 1,2013 Approved by Board Yes❑No❑ Agenda Date: Title of
Contract: Wellness Instructor
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: vl .27`,(3
IT Director
(Applicable only to hardwarefsoftware 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:
� .
Risk Manager's Signature: Date: J 1 I y
7a� . to 1 ze3
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No2/ A budget amendment is necessary
before approval Yes❑ Nolf. 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: UL t-, ��r - Date: I
County Attorney
Approval by Board ❑ (Contracts $90,000 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manager IkMost other contracts$1,000 and above). Department Director approval only❑(Under
S 1,000). This contract has bee viewed d approved by the Attorney as to legal form and suffici n y:
Attorney's Signature Date:
Count Countv Manager
This contract has been reviewed and is approved by the Coun Manager YesRPsIo❑.
This contract has been reviewed and is for signa a' Yes❑No "`
�
Manager's Signature: [Date: —3-
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