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HomeMy WebLinkAboutR 2014-372 Aging - Toni Campbell Shaw for wellness class 7Z 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 afproval. 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: Toni Campbell Shaw Party/Vendor Contact Person: same Contact Phone: Party/Vendor Address: 1301 Deerfield Trace City Mebane State:NC Zip:27302 Department:Aging Amount:$2,400.00 Purpose:Wellness Class Budget Code(s): 29430320-630000 Vendor#61838 (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 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 Director as to technical content: Department Director's Signature: Date: ///'f IT Director (Applicable only to hardwarelsoftware 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 Management 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 provisions as show by the Risk Manager: rrz Risk Manager's Signature: Date: JUL 11 2014 �r[,y Financial Services 74>L4-\ This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No❑. A budlLy 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 LocaAS.v ent Budget and Fisc Control Financial Services Director A�korv_114V'3�t Date: '7 It• ©! 1R County Attorney Approval by Board ❑ (Contracts $90,0001- 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC consultant contract). Approval by anager (Most other contracts$1,000 and above). Department Director approval only El (Under $1,000). This contract has been r v' ed 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 Yes B No❑. This contract has been reviewed and for si atur by the Chair Yes❑No❑. f Manager's 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