HomeMy WebLinkAboutR 2014-453 Finance - Orange County Rape Crisis Center - 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: Orange County Rape Crisis Center Party/Vendor Contact Person: Shamecca Bra Contact Phone: 919-968-4647
Party/Vendor Address: PO Box 4722 City Chapel Hill State:NC Zip:27515 Department: Finance&Admin. Services Amount:
$30,000 Purpose: Performance Agreement Budget Code(s): 10495050-710009 Vendor#800015 (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:
A Department Director's Signature: Date: Zl
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 shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: �p „%a C 11
81
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[� A budget amendment is necessary
before approval Yes[:] NoM.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:
Financial Services Director's Signature: N`(4- W Date: z
81Z0
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 Ma g X(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been revie e a d approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: 4711
County Manager
This contract has been reviewed and is approved by the County Manager Yesff No❑.
This contract has been reviewed and is si ture by e Chair Yes❑No❑.
Manager's Signature: Date:
Clerk to th oard
Approved by BOCC on the_day of 20 u i ed f r Chair signature on the da of 20
Clerk's Signature: Date:
Revised March 2012