HomeMy WebLinkAboutR 2014-435 Finance - Ligo Dojo - 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: Ligo Dojo Party/Vendor Contact Person: Nathan Ligo Contact Phone: 919-932-6915 Party/Vendor Address:
2518 Millwood Court A City Chapel Hill State:NC Zip: 27514 Department: Finance&Admin. Services Amount: $2,000 Purpose:
Performance Agreement Budget Code(s): 10495050-719068 Vendor#N/A (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:
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 Od ,
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR o Insuran ce Required ❑. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager: D ^M � 0 T R
Risk Manager's Signature:_ - Date: (�,�
AUG 19 2014
Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No A bu et amendment is necessary
before approval Yes❑NoPl. If budget amendment is necessary,please attach to this form. This instrume
manner required by the Local Government Bud et and Fiscal Contr 1 Act: y
Financial Services Director's Signature: Date: /V I
County Attorney
Approval by Board ❑ (Contracts $90,001D9 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval b9 Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has been rev ewed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature \ / �\ Date: IO
County Manager
This contract has been reviewed and is approved by the County Manager Yes[�].No❑.
This contract has been reviewed and is f signature by the Chair Yes❑No❑.
10
Manager's Signature: Date:
6
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