HomeMy WebLinkAboutR 2013-249 DEAPR - US TaeKwon Do Center Tae Kwon Do Instruction $3,675 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: US TaeKwon Do Center Party/Vendor Contact Person: Steve Kim Contact Phone: 919-730-3697 Party/Vendor
Address: 15201 Rose Garden Lane City Durham State:NC Zip:27707 Department: DEAPR Amount: $3675 Purpose: Tae Kwon Do
Instruction Budget Code(s): 630000 Vendor#61681 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract
Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date July 1,2013 Approved by Board Yes❑No® Agenda
Date: Title of Contract: Tae Kwon Do Instruction
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: r�,UC u T Date: lboll-1
IT Director
(Applicab on to hardware/software purchases or related services)This contract has been reviewed and approved by the Information
Technology ector as to technical content and information technology specifications:
IT Director's ignature: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required 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: JJ, Date:
Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑Nov A budget amendment is necessary
before approval Yes[]N 0 . If budget amendment is necessary, please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Bud et and Fiscal Cont r 1 Act:
Financial Services Director's Signature: N�1(i��✓ ��'✓ Date:
County Attorney
Approval by Board ❑ (Contracts $90,000.00 more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Managerell other contracts). This contract has been reviewed and approved by the Attorney as
to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by th unty Manager Y No❑.
This contract has been reviewed and is for sItr F�air Yes No
g g Mana er s Si nature: Date:
Clerk to the Board
Approved by O C on the_day of ,20 . Submitted for Chair signature on the day of 20
Clerk's Signatur . Date:
Revised November 2011