HomeMy WebLinkAboutR 2014-128 DEAPR - US Tae Kwon Do Center Inc. for Tae Kwon Do Instruction cote} -tez
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: U.S. Tae Kwon Do Center,Inc. PartyNendor Contact Person: Steve Kim Contact Phone: (919)730-3697
Party/Vendor Address: 15201 Rose Garden Lane City Durham State:NC Zip: 27707 Department:DEAPR Amount: $3925.20
Purpose: Tae Kwon Do Instruction Budget Code(s): Vendor#61681 (N/A if new vendor) Vendor is a BOCC consultant? Yes
❑
No Contract Type:(Check one)New ® Renewal❑ Amendment ❑ Effective Date 1/14/2014 Approved by Board Yes❑
Non Agenda Date: Title of Contract: Tae Kwon Do Instruction
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: i 123)14—
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 ?j
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Require Hold f
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: //49..oZ-,'rf/SD
Financial Services
This Contract is conditioned Won 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 Budget and Fiscal Control Act: �/ �p
Financial Services Director's Signature: aW�G�-4", J. Ji__.- Date: f(20�( 1
lt ..2•(l4
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 Manage, a ost other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been reviewed• an. .,'roved by the Attorney as to legal form and sufficiency:
Attorney's Signature G -- Date:
/-3 /f
County Manager
This contract has been reviewed and 's approved • the County Manager Yes o❑.
ifThis contract has been reviewed .••, for •n- ,e by the ha 1`des I,Oa
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