HomeMy WebLinkAboutR 2014-442 Finance - Community Empowerment Fund - 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: Community Empowerment Fund Party/Vendor Contact Person: Maggie West Contact Phone: 919-200-0233
Party/Vendor Address: 133 1/2 E.Franklin St., Suite 105 City Chapel Hill State:NC Zip: 27514 Department: Finance&Admin.
Services Amount: $5,000 Purpose: Performance Agreement Budget Code(s): 10495050-719064 Vendor#61695 (N/A if new vendor)
Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date
7/1/2014 Approved by Board Yes®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: .J Date: O ��
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 ❑. With incorporation of Insurance provisions as Mip3re-au roved
by the Risk Manager: �Risk Manager's Signature: �( �/ per ---- Date:Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[� A cess ry
before approval Yes❑ Zvrlf budget amendment is necessary, please attach to this form. This instr i e
manner required by the Local Government Budget and FiscalControl ct: /
Financial Services Director's Signature: XDa te:
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by ger[a(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been revi w d and a proved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: 3 125L 4—
County Manager
This contract has been reviewed and is approved by the County Manager Yes No❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
Manager's Signature: Date:
C7
Clerk to t1w Board
Approved by BOCC on the day of 120 d for Chair signature on the da of ,20
Clerk's Signature: Date:
Revised March 2012