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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: Freedom House Recovery Center Party/Vendor Contact Person: Trish Hussey Contact Phone:919-942-2803 <br /> PartyNendor Address: 104 New Stateside Drive City Chapel Hill State:NC Zip: 27516 Department:Outside Agency Amount: <br /> $28,000 Purpose:Outside Agency Budget Code(s): 10495050-710037 Vendor#800030 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes 0 No i4 Contract Type:(Check one)New Z Renewal 0 Amendment n Effective Date 07/01/2012 Approved by <br />■ Board Yes Z Non Agenda Date: 06/19/2012 Title o Contract:2012-13 Outside Agency Performance Agreement <br /> If this is a Grant Agreement,pre-application has been .apr ived by the Board of Commissioners Yes[]Non. If submitted for bid were <br /> bids/RFPs received Yesn Non Bid/RFP0 umber his contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> annian_--- .IIII II <br /> Department Director's Signatur.0 A=1111111 C-t' <br /> N ■Ik <br /> Date: <br /> 13 <br /> (Applicable only to hardware/software purchases or related se ,011.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 M nagement <br /> Include the following coverages: CGL; [ "Auto; C; g 0 n <br /> Professional; 0 Property; OR No Insurance Required . Hold <br /> E27 <br /> Contract pending receipt of Certificate of Insurance . With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: I <br /> Risk Manager's Signature: 'IL- -- <br /> ee j . Xi....., Date: / 'il 2 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes0Noill A budget amendment is necessary <br /> before approval Yesn No EM. 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 Bud e and Fiscal Control Act: <br /> ". ...e..„ ,, 0114 -- <br /> Financial Services Director's Signature: Date: -7/74 ft 2-- <br /> County Attorney <br /> Approval by Board xr.(Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Manager n -11 other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: A 1 <br /> 4 IL- Date: <br /> 1 <br /> Attorney's Signature <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Ye -No[]. <br /> This contract has been reviewed and is to be su'mitt-a or r,t consideration YeseNon. <br /> di Z.-- <br /> / , <br /> , AI 7 -217'-/ <br /> Manager's Signature: Date: <br /> lerk 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: Date: <br /> Revised April 2010 <br />