HomeMy WebLinkAboutR 2014-429 Finance - EmPOWERment, Inc. - 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: EmPOWERment, Inc. Party/Vendor Contact Person: Delores Bailey Contact Phone: 919-967-8779 Party/Vendor
Address: 109 N. Graham St.#200 City Chapel Hill State:NC Zip:27516 Department: Finance&Admin. Services Amount: $20,000
Purpose: Performance Agreement Budget Code(s): 10495050-789005 Vendor#800065 (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: j I
Department Director's Signature: U A— Date:
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 Ins ffRnae Rba e
Contract pending receipt of Certificate of Insurance El. With incorporation of Insurance provisions as shoe ct s p
by the Risk Manager: AUG 18 2014
Risk Manager's Signature: �4 Date:
gy I
Financial Services
This Contract is conditioned qpon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary
before approval Yes❑ NoIf 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 Contro Act:
Financial Services Director's Signature: 0144 ✓ Date:
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 anager[X (Most other contracts $1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been r vie ed a roved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: Cf
County Manager
This contract has been reviewed and is approved by the County Manager Yes o❑.
This contract has been reviewed and ' r sig ture b the Chair Yes❑No❑.
Manager's Signature: Date: -713
Clerk o Board
Approved by BOCC on the_day of ubmitted for Chair signature on the da/ of 20
Clerk's Signature: Date: <
Revised March 2012