HomeMy WebLinkAboutR 2014-288 Aging - Janice Galloway for Fit Feet clinic 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: Janice Galloway Party/Vendor Contact Person: same Contact Phone: Party/Vendor Address: 6615 Glen
Forest Drive City Chapel Hill State:NC Zip:27517 Department:Aging Amount: $8,000.00 Purpose:Fit Feet Clinic Budget Code(s):
29430320-622000 Vendor#58613 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)
New❑ Renewal® Amendment ❑ Effective Date 07/01/14 Approved by Board Yes❑NoZ Agenda Date: Title of
Contract: Wellness Instructor
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: wl-
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 Mananement
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: R 0 M � u nn M
Risk Manager's Signature:j4i� / " " Date: Olirby
JUN 10 2014
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No(V]". A bu amendment is necessary
before approval Yes❑No jVIf budget amendment is necessary,please attach to this form. This instrumen -
manner required by the Local Government Budget and Fiscal Control Act:
/✓�Financial Services Director's Signature: A--� Date:
County Attorney
Approval by Board ❑ (Contracts $90,00020 or more for goods or services, $250,000.00 or more for construction, or any BOCC
'ew
consultant contract). Approval by an ger W (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has been re and roved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is p ove y the County Manager YescTf4on.
This contract has been reviewed a s f ig a re he it es❑No❑.
C J
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