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Pr <br /> _7_,_-,:;?in <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 /> PartyNendor Name: Orange County Rape Crisis Center PartyNendor Contact Person: Shamecca Bryant Contact Phone:919-968-4647 <br /> PartyNendor Address: 1505 East Franklin STreet, Suite 302,PO Box 4722 City Chapel Hill State:NC Zip:27514 Department: <br /> Outside Agency Amount:$25,000 Purpose:Outside Agency Budget Code(s): 10495050-710009 Vendor#800015 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes❑NoZ Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective <br /> Date 07/01/2012 Approved by Board Yes No❑ Agenda Date:06/19/2012 Title of Contract:2012-13 Outside Agency <br /> Performance Agreement <br /> If this is a Grant Agreement,pre-application has •ee approved by the Board of Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes❑No❑ Bid/RFP n s r This contract has been reviewed and approved by the Department Director as to <br /> technical content: L <br /> Department Director' : gnature: �.,tlt/ -. Date: 2 --11,--1 L. <br /> T Director <br /> (Applicable only to ardware/software pure o es or r- • -d services)This contract has been reviewed and approved by the Information <br /> Technology Director : • -chnical content and information technology specifications: <br /> IT Director's Signature: Date: <br /> Risk M nagement <br /> Include the following coverages: dCGL; 'Auto; �WC; ['Professional; ❑ Property; ❑ OR No Insurance Required D. Hold <br /> Contract pending receipt of Certificate of Insurance Er. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: t/l n,� <br /> 4"-i >� Ali— Date: 1(1 - (Z <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑Nod A budget amendment is necessary <br /> before approval Yes❑No InY 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: C1 ._ .' i • A/1-4--- Date: u/7-111' <br /> County Attorney <br /> Approval by Board `j'r (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Manag- NI (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: I P <br /> Attorney's Signature �` i� : Z <br /> y g \. Date. 3 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Ye.sTallo0. <br /> This contract has been reviewed and is to be submitted for BOCC consideration Yes[21Qo 0. � <br /> Manager's Signature: , l , I / /0 Date: ^/ 169—/y <br /> Cler. to the Board <br /> Approved by BOCC on the day of ,21 . Submi d for Chair sign on the day of ,20 . <br /> Clerk's Signature: / /, Date: ) 2� <br /> Revised April 2010 <br />