HomeMy WebLinkAboutR 2013-406 Finance Boys & Girls Club of Eastern Piedmont $5,000 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: Boys&Girls Club of Eastern Piedmont Party/Vendor Contact Person: Sarah Marion Contact Phone:
Party/Vendor Address: P.O. Box 1788 City Pittsboro State:NC Zip: 27312 Department: Finance&Administrative Services Amount:
$5,000 Purpose: Outside Agency Budget Code(s): 10495050-719055 Vendor#62140 (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: June 18,2013 Title of Contract: 2013-14 Outside Agency Performance Agreement
If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Yeso 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: C✓` j` 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 Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance corporation of Insurance provisions as shown, this contract is approved
by the Risk Manager: (f_e V_W %&pr4e Cc
Risk Manager's Signature: ?Date: V
°l►1°I
Financial Services
This Contract is conditioned pon 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 Bud et and Fiscal Control Act: q
Financial Services Director's Signature:
�(ia�MUJ ^� Date: (.3
91<-13
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 Manag r (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has be re i wed ved by the Attorney as to legal form and suffici ncy:
Attorney's Signature Date:—0tt,
County Manager
This contract has been reviewed and is approved by qCI ger Yes No❑.
This contract has been reviewed and is for signature ❑No
Manager's Signature: Date:
he 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