HomeMy WebLinkAboutR 2014-382 Aging -Martha Hadden 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
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This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If Urc %tanager
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: Martha Hadden Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 1.110 f fan$
Knoll City Chapel Hill State:NC Zip:27514 Department:Aging Amount: $990.00 Purpose: Wellness Classes Budget C odc(s):
29430320-630000 Vendor#61008 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: ( heck one)
New❑ Renewal® Amendment ❑ Effective Date 07/01/2014 Approved by Board Yes[:]No® Agenda Date:___ l'itle 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 D.-partment Director as to
technical content:
Department Director's Signature: 4/, Date:
IT Director
(Applicable only to hardware/software purchases or related services)This contract has been reviewed and approv:d by the I r formation
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 [-I. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as sh r o Ir'tx a
by the Risk Manager: D
Risk Manager's Signature: Date: "2 i JUL 2
'71Z1
Financial Services
This Contract is conditioned ton appropriation by the Board of Commissioners Yes❑No[2/ A b By ajiRm_iEiRFw—i+4.
before approval Yes❑No[Y. If budget amendment is necessary,please attach to this form. This instrument haE been pre-audited in the
manner required by the Local Government Budget and Fiscal Control Act
Financial Services Director's Signature: C'�Jr'�"w L✓ ✓ . Ak4, 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 apy, BOCC
consultant contract). Approval b anager❑ (Most other contracts$1,000 and above). Department Director approval on I y (Under
$1,000). This contract has been vie ed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: -3
County Manager
This contract has been reviewed and is approved by the County Manager Yes[9io❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
Manager's Signature: lr `"r Date: t `7
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