HomeMy WebLinkAboutR 2014-497 Health - Evelyn Deloatch to assist OCHD to implement the CHHS Tobacco. Realty. Unfiltered (TRU) 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. Contacts 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: Evelyn Deloatch Party/Vendor Contact Person: Evelyn Deloatch Contact Phone: Party/Vendor
Address 8315 Mckee Rd City Durham State:NC Zip:27703 Department:Public Health Amount: $500.00 Purpose:Provider will
assist OCHD to implement the Chapel Hill High School Tobacco.REality.Unfiltered.(TRU) Budget Code(s): 10412020-630000
Vendor#52143 (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 ED
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:
LI
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 Re uired 71. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as sho ikEci ja�ijne by the Risk Manager: lV'J' I5 Risk Manager's Signature: � Date: SEP 1 9t LS Financial Services BY This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No� A budget amen men i
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 Ac :
Financial Services Director's Signature: ) �'�G�—l.�.i A I
g Date: a I
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or a BOCC
consultant contract). Approval by ager❑ (Most other contracts$1,000 and above). Department Director approval only (Under
$1,000). This contract has been re i d and approved by the Attorney as to legal form and sufficicie cy:
Attorney's Signature Date: L l'
County Manager
This contract has been reviewed and is approved by the County Manager Yes o❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
Manager's Signature: Date:
Cl to the Board
Approved by BOCC on the_day of . S miffed for Chair signature on the day of ,20
Clerk's Signature: A Date: al AV
Revised March 2012