HomeMy WebLinkAboutR 2014-239 Aging - Anna Miller for MAP long term care initiative 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: Anna Miller Party/Vendor Contact Person: same Contact Phone: Party/Vendor Address: 104 D West
Polar City Carrboro State:NC Zip:27510 Department:Aging Amount: $3,000.00 Purpose:MAP long term care initiative Budget
Code(s): 10430020-630120 Vendor#62470 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:
(Check one)New® Renewal❑ Amendment ❑ Effective Date 05/20/14 Approved by Board Yes❑No® Agenda Date:
Title of Contract:Master Aging Plan
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: d
Department Director's Signature: GtwLC.GC �E Date:
0 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 I fired Fnl. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as sh ,%&',�ola&Tar v
by the Risk Manager: v UU lJ
Risk Manager's Signature: � 0 0 Date: / MAY 19 2014
Financial Services By + �
This Contract is conditione4fpon appropriation by the Board of Commissioners Yes No A budget amendment is necessary
before approval Yes[:]NoK 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: (w.4, �• Date: 5 L
5lzo
County Attorney
Approval by Board ❑ (Contracts $90,000.6 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 a UT d by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: s Z�
County Manager
This contract has been reviewed and is a pro ed b e Cou ty Ma ager Yes No❑.
This contract has been reviewed an or na y ha' es o❑. p /
Manager's Signature: Date: O
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