HomeMy WebLinkAboutR 2011-028 Co Mgr - Adolescents in Need outside agency 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: Adolescents in Need Party/Vendor Contact Person: Betty Compton Contact Phone: 919-843-8263 Party/Vendor
Address: UNC Medical School City Chapel Hill State:NC Zip: 27515 Department: Outside Agency Amount: $32,194 Purpose:
Budget Code(s): 10495050 710010 Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract
Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1,2010 Approved by Board Yes®No❑ Agenda
Date: June 15,2010 Title of Contract: 2010-11 Outside Agency Performance Agreement
If this is a Grant Agreement,pre-application has been approved y t Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes[]No❑ Bid/RFP numb e ont act has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date: 0
P g
IT . ector
(Applicable only to hardware/sof4vare 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 El. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date:
Financial Services
This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary
before approval Yes❑ NoZ If budget amendment is necessary,please attach to this form. h s instrument has been pre-audited in the
manner required by the Local Government Budget'and Fiscal Control Act:
Financial Services Director's Signature: �'�+�`' , � Date: � 3' � �
A
County Attorney
Approval by Board X(Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Manag r (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Date: 1 3( 1
County Manager
This contract has been reviewed and is approved by the County Manager Ye's❑No❑.
This contract has been reviewed and is to be submitted for BOCC consideration Yes No
Manager's Signature: Date: — ( r
Clerk to the Board 9
Approved by BOCC on the L-'�day of 8ubmitted for Chair signature on the day of /60
Xx --
Clerk's Signature: Date: 9
Revised April 2010