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a�la -1510 �2c�.�h Zc7 J2- l5�> <br />ORANGE COUNTY — CONTRACT CONTROL SHEET <br />Routing Order: (1) Department, (2) IT, (3) Risk Management, (4) Financial Services, (5) Attorney, (6) Manager, (7) Clerk <br />This Document shall accompany all contracts 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 BOCC approval. Contracts for <br />BOCC 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 Name: Wellness Instructors Party/Vendor Contact Person: see attached Contact Phone: Party /Vendor <br />Address: City State: Zip: Department: Aging Amount: 2 0$ 00..00 Purpose: classes Budget Code(s): <br />29430320 - 630000 Vendor # (N /A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) <br />New ❑ Renewal ® Amendment ❑ Effective Date 07/01/2012 Approved by Board Yes[] No® Agenda Date: Title of <br />Contract: <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 /RFPs received Yes❑ No❑ Bid/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 only to hardware /software purchases or related services) This contract has been reviewed and approved by the Information <br />Technology Director as to technical content and information technology specifications: <br />IT Director's Signature: <br />Date: <br />Risk Management <br />Include the following coverages: El CGL; ❑ Auto; ❑ WC; E] Professional; ❑ Property; OR No Insurance Required [' Hold <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 />Risk Manager's Si nature: Date: % t <br />Financial Services <br />This Contract is conditio Xcdi, on app ropriation by the Board of Commissioners Yes ❑No A budget amendment is necessary <br />before approval Yes❑ NIf budget amendment is necessary, please attach to this form. Thi instrument has been pre- audited in the <br />manner required by the Lovernment Budge and Fiscal Con rol A <br />Financial Services Director's Signature: ( /n��t� Date: <br />County Attorney <br />Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br />consultant contract). Approval by Manager ❑ (Most other contracts $1,000 and above). Department Director approval only (Under <br />$1,000). This contract has bee eviewed and approved by the Attorney as to legal form and sufficiency: <br />Attorney's Signature Date: is �2 <br />County Manager <br />This contract has been reviewed and is approved by the County Manager Yegn�No ❑. <br />This contract has been reviewed and is for signature by th Chair Yes❑1�- <br />Manager's Signature: Date: <br />Clerk to the Board <br />Approved by BOCC on the _ day of , 20 . Submitted for Chair signature on the _day of 20 <br />Clerk's Signature: <br />Revised March 2012 <br />Date: <br />