HomeMy WebLinkAboutR 2014-474 Health - Shari Coveney to assist OCHD to implement the CH High School Tobacco. Reality. Unfiltered. (TRU) Group 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: Shari Covenev Party/Vendor Contact Person: Shari Covenev Contact Phone: Party/Vendor Address: 1622
Worth Street City Hillsborough State:NC Zip:27278 Department:Public Health Amount: $500.00 Purpose: Provider will assist
OCHD to implement the Carrboro Huh School Tobacco Reality.Unfiltered.(TRU)Group Budget Code(s): 10412020-630000 Vendor
#62244 (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
2015 Title of Contract: TRU Club Advisor SC
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: �'� 'I q
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 Mana¢ement
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required E. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as showi 1,D tcgc I aTrr
by the Risk Manager: LC l�r
Risk Manager's Signature: Date: / AUG 2 8 2014
Financial Services By
This Contract is conditioned y�pon appropriation by the Board of Commissioners Yes❑ .No A budg
before approval Yes❑No 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: Date: P 3
IL3
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or an BOCC
consultant contract). Approval b Manager El (Most other contracts$1,000 and above). Department Director approval only any
$1,000). This contract has been e i wed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: —6
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