HomeMy WebLinkAboutR 2014-175 Aging - Triangle J Council of Governments for Home & Community Care Block Grant 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: Triangle J Council of Governments Area Agency on Aging Party/Vendor Contact Person: Joan Pellettier Contact
Phone:919-558-9398 Party/Vendor Address:4307 Emperor Blfd., Suite 110 City Durham State:NC Zip:27703 Department:Aging
Amount: $490,460 Purpose:Home and Community Care Block Grant Budget Code(s): 10430120&10432020 Vendor#5855 (N/A if
new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Che one)New❑ Renewal® Amendment ❑
Effective Date 07/01/13 Approved by Board Yes No❑ Agenda Date:�itle of Contract:AA. -eement for Provision of
County-Based Aging Services
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:
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
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: LnUU�11 L a L'l T
Risk Manager's Signature: Date: � R - 4 214-x+171��+ Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[/ A bment is necessary
before approval Yes❑No[VIf budget amendment is necessary,please attach to this form. This instrum1173S MT11
manner required by the Local Government Budget and (J
d Fiscal Control Act: �J
Financial Services Director's Signature: �ay"t., ,, . A-.4— Date: f '
County Attorney
Approval by Board N (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 bee revie and approved by the Attorney as to legal form and suffici nc :
Attorney's Signature Date: $ 14
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