HomeMy WebLinkAboutR 2013-500 Health - James Wise True Club Advisor Progra $500 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: James Wise 1PartyNendor Contact Person: James Wise Contact Phone: 919-380-1042 Party/Vendor Address:
2324 Woodbury Drive City Hillsborough State:NC Zip:27278 Department: Public Health Amount: $500.00 Purpose: Provider will
work with OCHD with the 2013-2014 TRU Club Advisor program Budget Code(s): 10412020-630000 Vendor#603260 (N/A if new
vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective
Date September 1,2013 Approved by Board Yes[]No❑ Agenda Date: Title of Contract: TRU Club Advisor
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❑Nor-] Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: ~ Date: ► - l�
etr
"'Z only to hardware/software purchases or related services)This contract has been reviewed and approve y
Technology Director as to—re—chmee s ecifications:
If 091 ectul's %gftfttHiT_. _
Risk Management
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: W ft,'1-'--d- uC g"%-sa(
Risk Manager's Signature:_, Z Date:
1zim
Financial Services
This Contract is condi ' ned upon appropriation by the Board of Commissioners Yes[jNo[]. A budget amendment is necessary
before approval Yes2No❑. 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 a and Fiscal Control Acct:: J
Financial Services Director's Signature: l�►. +�` J 4— Date: tZ S-1 1.3
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(Under
$1,000). This contract has be r view an approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by the County Manager Yes❑No❑.
This contract has been reviewed and is for signature by the Chair 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