HomeMy WebLinkAboutR 2014-371 Aging - Nancy Dede Banks for wellness class ,�?o1- -�3`7 I
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: Nancy Dede Banks Party/Vendor Contact Person: same Contact Phone: Party/Vendor Address: 747 Rock
Rest Road City Pittsboro State:NC Zip:27312 Department:Aging Amount: $3,000.00 Purpose:Wellness Class Budget Code(s):
29430320-630000 Vendor#55776 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)
New❑ Renewal® Amendment ❑ Effective Date 07/11/14 Approved by Board Yes❑No® Agenda ate: 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: 7-11-1-1
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 Manaizement
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 pro4ah sV n 1
by the Risk Manager: 5 L LC
Risk Manager's Signature: ae. P Date: JUL 1 1 Z O 14
Financial Services This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No
before approval Yes[]No❑. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Control Act: 04-4 !ZA"im
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14 Financial Services Director's Sign ur . ate:
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County Attorney
Approval by Board ❑ (Contracts $90,000 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by ager[(Most other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has been r vo ed and approved by the Attorney as to legal form and suffici ncy:
Attorney's Signature Date: q,
County Manager
This contract has been reviewed and is approved by the County Manager Yes❑No❑.
This contract has been reviewed and it sigma ure by the Chair Yes❑No❑.
Manager's Signature: r Date:
Cler 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