HomeMy WebLinkAboutR 2014-349 DEAPR - U.S. Tae Kwon Do Center, Inc. for tae kwon do instruction .?OL4— =_�(4n
ORANGE COUNTY-CONTRACT CONTROL SHEET
Routing Order: (1)Department, (2)IT,(3)Risk Management, (4)Financial Services,(5)Attorney,(6)Manager,(71 ('1(:-k
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This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. It thy 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 r:,. c.,\ 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. Party/Vendor Contact Person: Steve Kim Contact Phone: (919)73(,-,!,k)'
Party/Vendor Address: 15201 Rose Garden Lane City Durham State:NC Zip: 27707 Department: DEAPR Amount: $50! ,� (n t
Purpose: Tae Kwon Do Instruction Budget Code(s): Vendor#61681 (N/A if new vendor) Vendor is a BOCC con,Ot.int? Yes
❑No® Contract Type: (Check one)New ® Renewal❑ Amendment ❑ Effective Date 7/1/2014 Approved by Board l s❑No
❑ 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 submitte._i too hid were
bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department I Nvctor as to
technical content:
Department Director's Signature: Date: . 12 4-:—
IT Director
(Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the I n turmation
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 Insur e li't:i" D,
Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown o act is ipio ' ^I
by the Risk Manager:
JUl 014
Risk Manager's Signature: Date: Z71131
'717 By �
Financial Services
This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑No[q' A budget amendmeni necessary
before approval Yes❑Noy. If budget amendment is necessary,please attach to this form. This instrument has been pre mid itcd in the
manner required by the Local Government Budget andFiscal Control Act: 1
Financial Services Director's Signature: U"4A, Date: `l
'11'1
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, )i , \ BOCC
consultant contract). Approval by Manager Most other contracts$1,000 and above). Department Director approval pan [] (Under
$1,000). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by the County Manager YesPNo❑.
This contract has been reviewed and is or-�tg`n at we b
Cha ir air� Yes❑No❑.
Managers 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