HomeMy WebLinkAboutR 2014-490 Finance - Boys & Girls Club of Eastern Piedmont - 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: Boys&Girls Club of Eastern Piedmont Party/Vendor Contact Person: Marvwinne Sherwood Contact Phone: 919-
663-6159 Party/Vendor Address: PO Box 1788 City Pittsboro State:NC Zip: 27312 Department: Finance&Admin. Services
Amount: $2,000 Purpose: Performance Agreement Budget Code(s): 10495050-719055 Vendor#62140 (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: /y
Department Director's Signature: ��G' (•� �' /� Date: `q
144/Y
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 R. Hold
Contract pending receipt of Certificate of Insurance R. With incorporation of Insurance provisions as show mcnW q�prm
by the Risk Manager: �I u uu
Risk Manager's Signature: ( A� — ... Date: SEP 1 1 2014
Financial Services By
This Contract is conditioned Oon appropriation by the Board of Commissioners Yes❑Nom/ A budgetc
❑
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 pct: r
Financial Services Director's Signature: jjaA �C�✓ /j4A<_ Date: I/ 1 sj)y
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 a ager&(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been rev ew 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 ❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
Manager's Signature: Date: p !�
Clerk to the Board
Approved by BOCC on the_day of 120 Submitted for Chair signature on the_day of ,20
Clerk's Signature: Date:
Revised March 2012