HomeMy WebLinkAboutR 2013-475 DEAPR - Hillsborough Youth Athletic Association - Field Lease Agreement $0 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: Hillsborough Youth Athletic Association Party/Vendor Contact Person: Donnie Dement Contact Phone: 336-516-
0708 Party/Vendor Address: PO Box 577 City Hillsborough State:NC Zip: 27278 Department: DEAPR Amount: 0 Purpose: Field
Lease Agreement Budget Code(s):n/a Vendor#n/a (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract
Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date Approved by Board Yes❑No® Agenda Date:
Title of Contract:
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: Date:
—r j1�V i� vC3Sict1 d�
IT D' ector IGSt-yCcr'S
(Applicable only to hardware/software purchases or relate servic s)This contract has been reviewed and of fir' Me ", Ord
Technology Director as to technical content and information t ology specifications: J'a a
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 0. 'Wi incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: c-e
Risk Manager's Signature:
2=Q t, — Date: d l NIO
Financial Services
This Contract is conditioned tpon appropriation by the Board of Commissioners Yes❑Nold A budget amendment is necessary
before approval Yes❑ NoIf. budget amendment is necessary, please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Bu/d�geeta and Fiscal Co rol/Act:
Financial Services Director's Signature: Date: l� l
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 Manager2r(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency:
>l
Attorney's Signature Date:
County Manager
This contract has been reviewed a is ppr d by the Count Manager Yes No❑.
This contract has been review nd i for atur the it 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:
Revised March 2012