HomeMy WebLinkAboutR 2014-381 Aging - Kathleen Hammon for wellness classes 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 t+ie Manager
determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC ipproval. Contracts for
BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal ncyie\, should
be completed through the legal review process prior to being routed for signature.
Department
Party/Vendor Name: Kathleen Hammon Party/Vendor Contact Person: Contact Phone: Party/Vendor Address 1 102 E.
Franklin Street City Chapel Hill State:NC Zip:27514 Department:Aeipg Amount: $4,000.00 Purpose:Wellness Classes Budget
Code(s): 10430120-770105 Vendor#56311 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No[g Contract l N pe:
(Check one)New ❑ Renewal® Amendment ❑ Effective Date 07/01/2014 Approved by Board Yes❑No 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 1,)i rector as to
technical content:
Department Director's Signature: Date: 7-1(,-1q,
IT Director
(Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the I nformation
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 E]. With incorporation of Insurance provisions as sho iL contr4c_t_is angroy ed
by the Risk Manager: D
Risk Manager's Signature: .4 Date:Z 71J!4 JUL 14
�Izt
Financial Services
This Contract is conditioned t on appropriation by the Board of Commissioners Yes❑No A bud %amendment is necessary
before approval Yes❑No If budget amendment is necessary,please attach to this form. This instrument ai een prit-aLid;ie m t e
manner required by the Local Government Budget/and Fiscal Con tro Act: J
Financial Services Director's Signature: Al_ Date:
County Attorney
Approval by Board ❑ (Contracts $90,000 00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manag [(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been reviewed approved by the Attorney as to legal form and sufficiency-
Attorney's 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 sign*u`rree by the Chair Yes❑No❑.
Manager's Signature:
r? '� 1 Date: / � �
r
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