HomeMy WebLinkAboutR 2014-423 Health - Functional Fitness to teach the exercise component �C)
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: Functional Fitness Party/Vendor Contact Person: Kevin Kirk Contact Phone: Party/Vendor Address: 605
Eastowne Dr. Suite C City Chapel Hill State:NC Zip:27514 Department:Public Health Amount: 600 Purpose: Teach the exercise
component Budget Code(s): 10414020-630000 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No®
Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date July 1,2014 Approved by Board Yes❑No❑
Agenda Date: Title of Contract: DSME-FF
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:
PP ' l to hardware/software purchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to ec formation technology specifications:
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 i�c- t�q affrTr
by the Risk Manager: n LL55 ((�S �J
Risk Manager's Signature: . 0 Date: / _ AUG — H 2014
�lg
Financial Services By
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[i/ A budgeta
before approval Yes No[vlf budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Bud et/,,�1an'd Fiscal Control Ac
g
Financial Services Director's Signature: Vt"IM,C.— /✓� 1, Date:
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 pager L8(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has been rev a ed roved 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 No❑.
This contract has been reviewed and is for 'gnature by the Chair Yes❑No❑.
Manager's Signature: Date: l
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