HomeMy WebLinkAboutR 2013-259 DES - Charles House Associates for Adult Day Services to Clients of Orange County $25,000 ac�13_ a5
ORANGE COUNTY-CONTRACT CONTROL SHEET
Routing Order: (I)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: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone: 919-967-7570
Party/Vendor Address: 109 Hillcrest Ave City Carrboro State:NC Zip: 27510 Department: DSS Amount: $25.000 Purpose:Adult
Day Services to clients of Orange County Budget Code(s): 10405020-764100 Vendor# 19446 (N/A if new vendor) Vendor is a
BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date 07/01/14
Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Charles House Association
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: ,2 7y
Department Director's Signature: 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 Mana ement
Include the following coverages: BYCGL; [Auto; C; rofessional; ❑ Property; OR No Insurance Required El. 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: 044V4.., Date:
[17 �3
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary
before approval Yes❑ No V.. 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 nd Fiscal Control Act-
Financial Financial Services Director's Signature: l�C �- /,� /� Date:
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 Maria er X(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has be r view d d approved by the Attorney as to legal form and sufficiency,-
Attorney's Signature Date: 1 1
County Manager
This contract has been reviewed and is approved by the C ity Manager Yes o❑.
This contract has been reviewed and is for signature b t air Yes❑No
Manager's Signature: Date:
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:
vised March 2012