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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 /> PartyNendor Name: Planned Parenthood of Central NC PartyNendor Contact Person: Elizabeth Irwin Contact Phone:919-929-5402 <br /> PartyNendor Address: 1765 Dobbins Drive,PO Box 3258 City Chapel Hill State:NC Zip:27514 Department:Outside Agency <br /> Amount:$20,000 Purpose:Outside Agency Budget Code(s): 10495050-710013 Vendor#800040 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes 0 No Contract Type:(Check one)New El Renewal 0 Amendment El Effective Date 07/01/2012 <br /> Approved by Board YesEj No0 Agenda Date:06/ 9/2012 Title of Contract:2012-13 Outside Agency Performance Agreement <br /> If this is a Grant Agreement,pre-application has b en a,proved by the Board of Commissioners Yes0 No0. If submitted for bid were <br /> bids/RFPs received Yes0 No0 Bid/RFP / rn This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Allig Ilk <br /> ( Wil <br /> Department Director's Sign: re: AMMON'CAN A Date: 7— it — / • <br /> ,... <br /> vir, <br /> 11 II ector <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: Date: <br /> Risk Management <br /> Include the following coverages: [ "CGL; E2 Auto; WC; [ 'Professional; 0 Property; 0 OR No Insurance Required 0. 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 Signature: U-11"4-' A , i.---- Date: 1(14 17- <br /> Financial Services <br /> This Contract is conditioned 9pon appropriation by the Board of Commissioners Yes0No[Yr A budget amendment is necessary <br /> before approval Yes[]No If budget amendment is necessary, please attach to this form. This instrument has been pre-audited in the <br /> manner required by the Local Government Budget and Fiscal Control Act: <br /> Financial Services Director's Signature: etee-4 4_‘......- .i. jitic-/' Date: 171 I z-I r9-- <br /> County Attorney <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 CI (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> 11 Date: 1 <br /> Attorney's Signature ill -PA <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YesL:g-No[ ]. <br /> This contract has been reviewed and is to be submitted for BOCC cons'i tion Yes12Mo0. <br /> Manager's Signature: # <br /> 1 , 1 0/ / <br /> Date: 7--(6, /Z-- <br /> Clerk to t e Board <br /> Approved by BOCC on the day of Submitted for Chair signatik4 <br /> l e day of ,20 . <br /> i ar <br /> Clerk's Signature: Date: 1 7/'7//\._ <br /> Revised April 2010 <br />