HomeMy WebLinkAboutR 2014-470 Health - Linda Karcher to assist OCHD to implement the CH High School Tobacco. Reality. Unfiltered. (TRU) Group 4-10
ORANGE 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: Linda Karcher Party/Vendor Contact Person: Linda Karcher Contact Phone: Party/Vendor Address: 95
Carson Ct. City Pittsboro State:NC Zip:27312 Department:Public Health Amount: $500.00 Purpose:Provider will assist OCHD to
implement the Carrboro High School Tobacco.Reality.Unfiltered. (TRU)Group Budget Code(s): 10412020-630000 Vendor#57568
(N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New❑ Renewal ® Amendment
❑ Effective Date September 1,2014 Approved by Board Yes❑No❑ Agenda Date: September 1,2014-July 31,2015 Title of
Contract: TRU Club Advisor LK
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:
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 E7 Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: � � R U U M
Risk Manager's Signature: ` ,1 ._- Date:
8127 AUG 2 G 2014
Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑NoY A b t amendment is necess
before approval Yes❑Nov If budget amendment is necessary,please attach to this form. This instrume
manner required by the Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature: el 4w,► W P` A,� Date:
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or aqy BOCC
consultant contract). Approval by ger❑ (Most other contracts$1,000 and above). Department Director approval only (Under
$1,000). This contract has been revi and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: O
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:
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