HomeMy WebLinkAboutR 2014-433 Finance - Charles House Association - Outside Agency Performance Agreement 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: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone: 919-967-7570
Party/Vendor Address: 109 Hillcrest Avenue City Carrboro State:NC Zip:27510 Department: Finance&Admin. Services Amount:
$15,000 Purpose:Performance Agreement Budget Code(s): 10495050-710029 Vendor#800031 (N/A if new vendor) Vendor is a
BOCC consultant? Yes E]NoN Contract Type: (Check one)NewEJ Renewal E Amendment ❑ Effective Date 7/1/2014
Approved by Board YesZ No❑ Agenda Date:6/17/2014 Title of Contract:2014-15 Outside Agency Performance Agreement
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: Wjj�,fX, Date: 0 (2
A4 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 Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required Hold
Contract pending receipt of Certificate of Insurance R. With incorporation of Insurance provisions as sh v d
by the Risk Manager:
as ved
s s
Risk Manager's Signature: � k Date: '?
''lu AUG 18 2014
Financial Services
This Contract is conditioned Aon appropriation by the Board of Commissioners Yes❑Now Ab
-
before approval Yes❑NorO. If budget amendment is necessary,please attach to this form. This instrument has been leis
-audited in t e
manner required by the Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature:_Nye ..t,4- A AAAo- l Date: �Pl 14
County Attorney
Approval by Board E] (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by,44anagero(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has been r vi ed roved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manage
This contract has been reviewed and is approved by the County Manager Yes Wl NoR.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
12
Manager's Signature- / 7 Date:
Clerk to the Aard
Approved by BOCC on the_day of 20__. Submit hair signature on th� y of 120
Clerk's Signature: Date:
Revised March 2012