HomeMy WebLinkAboutR 2010-054 DSS - Flaircare in home services 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: Flaircare Party/Vendor Contact Person: Anzor Gachechiladze Contact Phone: 919-960-6038 Party/Vendor
Address: 1004 Mount Carmel Ch Rd City Chapel Hill State:NC Zip:27517 Department:DSS Amount: Purpose: In home
service Budget Code(s)-1,v' ndor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type:
L
(Check one)New❑ Renewal ® Amendment ❑ Effective Date Approved by Board Yes®No❑ Agenda Date:
Title of Contract:
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: 6(0'3 D _16
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 Required ❑. 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: 4^- Date:
_WC Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No)O. A budget amendment is necessary
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: Nat4w Date:-*Of 7zr-n
County Attorney
Approval by Board (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by a ager (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Datel lb Zboo
County Manager
This contract has been reviewed and is approved by the County Manager Yes❑No❑.
This contract has been reviewed and is to be submitted for BOCC consideration Yes❑No❑.
Manager's Signature: Date:
Clerk to the Board
Approved by BOCC on the da of ,20 Submitted for Chair signature on the day of ,20
Clerk's Signature: Date:
Revised April 2010