HomeMy WebLinkAboutR 2013-437 Health - Cristina Sansone to improve knowledge of safe sexual behavior among teens & Increase HPV Vaccination rates $1,241 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: Cristina Sansone Party/Vendor Contact Person: Cristina Sansone Contact Phone: 919-245-2379 Party/Vendor
Address:Bertland Avenue' City Durham State:NC Zip:27705 Department: Public Health Amount: $1,241 Purpose: Improve
knowledge of safe sexual behavior and to increase in HPV vaccination rates among teens eens Budget Code(s): 10414020-680018 Vendor#
60833 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New ® Renewal❑
Amendment ❑ Effective Date September 30,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Teen
Health Advocate
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:
to-r-13
Department Director's Signature: __ _ __ Date:
I free or
(Applicable only to hardware/software purchases or related services)This contract has been reviewed and apgrov
Technology Director as to technical content and information technolo
IT Director's S'
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Prefessional; ❑ 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: Date: d
10�1U
Financial Services
This Contract is conditioned a on appropriation by the Board of Commissioners Yes❑Nov 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 Budget and Fiscal Control AcJt`:��
Financial Services Director's Signature: � (�'' �� ✓ ° - Date:
io(to
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 (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has be vie e and approved by the Attorney as to legal form and sufficient
Attorney's Signature Date:
County Manager
This contract has been reviewed and 's a rov by the County anage r Yes o❑.
This contract has been reviewe is s' ture the it ❑No❑.
Manager's Signature: Date: 0
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