HomeMy WebLinkAboutR 2014-380 Aging - Senie Wolfe 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. 11 the Nlanager
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 rep iew should
be completed through the legal review process prior to being routed for signature.
Department
Party/Vendor Name: Senie Wolfe PartyNendor Contact Person: Contact Phone: Party/Vendor Address: 9Q9 Palmers
Grove Church Road City Hillsborough State:NC Zip:27278 Department:Aging Amount: $2,400.00 Purpose Wellness Classes
Budget Code(s): 10430120-770105 Vendor#58051 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑NoEl Contract
Type: (Check one)New ❑ Renewal® Amendment ❑ Effective Date 07/01/2014 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 I)irector as to
technical content:
Department Director's Signature: Date: 7-/(/f
IT Director
(Applicable only to hardware/software purchases or related services)This contract has been reviewed and appro-ed by the 111 formation
Technology Director as to technical content and information technology specifications:
IT Director's Signature: Date:
Risk Management 041113-
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required D. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown h;c contrast.is approved
by the Risk Manager: D 1 C' M (�
Risk Manager's Signature: Date: 7 7 lU LI L5
'7lZi Jul 014
Financial Services
This Contract is conditionedfpon appropriation by the Board of Commissioners Yes❑No[i/ A budge Eohendmert is necessary
before approval Yes❑NoLM. If budget amendment is necessary,please attach to this form. This instrument has been pre=au"d4& m e
manner required by the Local Government Budget and Control Act*
Financial Services Director's Signature: `U 4." sue? � Date: / �Z
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or an' BOCC
consultant contract). Approval by M er (Most other contracts$1,000 and above). Department Director approval on I (Under
$1,000). This contract has been revi we and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: Z,
County Manager
This contract has been reviewed and is approved by the County Manager YesgNo❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
Manager's Signature: Date:
Jerk 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