HomeMy WebLinkAboutR 2013-277 Aging - UNC Center for Health Promotion and Disease Prevention $9,100 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: UNC Center for4fealth Promotion and Disease Prevention Party/Vendor Contact Person: Cherie Rosemond
Contact Phone:919-906-9334 P4rtyNen or dress: 1700 MLK Jr Blvd,CB 7426 City Chapel Hill State:NC Zip:27599-7426
Department: Aging Amount: $9 100.0 P os :MAP Study Budget Code(s): 10430020-630120 Vendor# 10419 (N/A if new vendor)
Vendor is a BOCC consults Yes o® Contract Type:(Check one)New® Renewal❑ Amendment E:1 Effective Date July
22,2013 Approved by Bo d No❑ Agenda Date: Title of Contract: MAP Housing Study
If this is a Grant Agreeme -application has been approved by the Board of Commissioners Yes❑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: Date: 7 Z4-/3
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 Mana¢ement
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: �j OFPW'a 1))*tMA Date:
Financial Services
This Contract is conditioned u appropriation by the Board of Commissioners Yes❑No❑. A budget amendment is necessary
before approval Yes❑ No . If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Bu and Fiscal Control Act:
Financial Services Director's Signature: ;,x 'h l� Date: ? Z2 3
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manager (Most other contracts$1,000 and above). Department Director approval only E] (Under
LA$1,000). This contract has be reviewed and approved by the Attorney as to legal form and suffic'ency:
Attorney's Signature /" ` Date:
County Manager
This contract has been reviewed and is approved by the Counly Manager Yes;2No❑.
This contract has been reviewed and is for nature by the Chair YesE]NoLiK
,j Manager's Signature: Date:
erk 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