HomeMy WebLinkAboutR 2013-505 Aging - UNC Center for Health Promotion and Disease Prevention MAP Housing Study $9,900 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: UNC Center for Health Promotion and Disease Prevention Party/Vendor Contact Person: Randy Bickford Contact
Phone:919-962-4680 Party/Vendor Address: 104 Airport Dr.,Ste 2200 City Chapel Hill State:NC Zip:27599 Department:Aline
Amount: $9,900.00 Purpose:MAP Housing Study Budget Code(s): 10430020-630120 Vendor# 10419 (N/A if new vendor) Vendor
is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 12/01/13
Approved by Board Yes❑No[] Agenda Date: Title of Contract:MAP Housing Studv
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; Ae-11-1_4
IT Director
(Applicable only to hardwarelsoftware 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 ❑. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: �. ,` 1�2��s — Date: -
lz � ii
Financial Services
This Contract is condi 'oned upon appropriation by the Board of Commissioners Ye&No❑. A budget amendment is necessary
before approval Yes91 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 Act:
Financial Services Director's Signature: �a.�i.,4✓ /A .�h�M� Date: L 1-T
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 been rev i d and rov y the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is ap ov by the County Manager YesErNoEl
This contract has been reviewed s f r si a e t o it ❑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 120
Clerk's Signature: Date:
Revised March 2012