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+ � 1 NGE C iT C NTR CT; C NT . SHEET <br />Routing Order: l Department, IT, Risk Management, Financial Services, Attorney, Manager, 7 Clerk <br />This Document shall accompany all eontracts and shall be submitted for signature in the Routing Order specified above. If the Manager <br />determines the contract is not appropriate for Manager approval the Manager shall submit the contract for B CC approval. Contracts for <br />B CC approval must be submitted through, and complete, the routing process prior to agenda review. Contracts for legal review should <br />be completed through the legal review process prior to being routed for signature. <br />Department <br />Party /Vendor Narne: Johnnie Belli Party/ Vendor Contact Person: Contact Phone: PartyNendor Address: 1011 Castor <br />Ave City Durham State: NC Zip; 27707 Department- Aging AMOLint: $1,000.00 purpose: activity instructor Budget Code(s) : <br />10432020- 630102 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant ` YYes El NoZ Contract Type: (Check oil e) <br />New M Renewal ❑ Amendment ❑ Effective Date 03701/12 Approved by Board Yes❑ No❑ Agenda Date: Title of <br />Contract: Senior Center Instructor <br />If this is a Grant Agreement, pre - application has been approved by the Board of Commissioners Yes[:] No❑. If submitted for bid were <br />bids R l s received Yes❑ No❑ id RFP number This contract has been reviewed and approved by the Department Director as to <br />technical content: <br />Department Director's Signature: Date: <br />IT Director <br />(Applicable on ly to hardwarelsoftware purc h s or related services) This contract has been reviewed and approved by the Inf rmation <br />Technology Director as to technical content and information technology specifications: <br />IT Director's Signature. <br />Date: <br />Disk Man ernent <br />Include the following coverages: ❑ C L; ❑ Auto; ❑ WC; ❑ Professional; [:] Property; � No Insurance Required ❑. Mold <br />Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved <br />by the Risk Manager: <br />Kish Manager's Signature: 4-ol Date: 2-, Z�5 f � <br />Financial Services <br />This Contract is condition d upon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary <br />before approval Yes❑ No W. If b ` udget amendment is necessary, please attach to this form. This instrument has been pre- audited in the <br />manner required by the Local Govemment Budget and Fiscal Control Act: <br />Financial Services Director's Signatur e. Date: 2`w► 2 �, )L <br />County Attorn <br />Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br />contract). Approval by Manager (All other contracts). This contract has been reviewed and approved by the Attonley as to legal <br />form and sufficiency: <br />Attorney's Signature Date: �z azc <br />County Manager <br />This contract has been reviewed and is approved by the County Manager Yep No ❑. <br />This contract has been reviewed and is to be submitted for BCC consideration Yes ❑On. <br />f� Ifr I <br />Manager's Si nature: t Date: <br />Clerk to the Board <br />Approved by BCC on the clay of , 20 Submitted for Clair signature on the day of , 2 <br />Clerk's Sigtta ure. Date. 2�, <br />UU <br />Revised April 2010 <br />