HomeMy WebLinkAboutR 2014-176 Aging - NC Division of Aging and Adult Services 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: NC Division of Aging and Adult Services Party/Vendor Contact Person: Melvinna Adams Contact Phone:919-
855-3438 Party/Vendor Address: 693 Palmer Drive City Raleigh State:NC Zip:27699 Department:Aging Amount: $25,000
Purpose:Caregiver Support Training Grant Budget Code(s): 10432005-444121-71087 Vendor#56275 (N/A if new vendor) Vendor
is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 03/21/14
Approved by Board Yes❑No❑ Agenda Date: Title of Contract:Amendment
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: 3
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 proviAah Zpre-audited
by the Risk Manager:
Risk Manager's Signature: � Date:.Financial Services
This Contract is conditioned u on appropriation by the Board of Commissioners Yes❑No[
before approval Yes❑No�If budget amendment is necessary,please attach to this form. This instrument ha
manner required by the Local Government Budget and Fiscal Control Act::
j Financial Services Director's Signature: �'J• .�'V� Date: -31a l I g
-417
County Attorney
Approval by Board ❑ (Contracts $90,00Q.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval Manager D(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has beer r iew approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: $ �--
County Manager
This contract has been reviewed and ' ap rov y the Coun Mana er Yes o❑.
This contract has been reviewed is f si ure e it rNoEl.
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