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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 /> Party/Vendor Name: Pascale Mittendorf Party/Vendor Contact Person: SAME Contact Phone:919- Party/Vendor Address: 1 Winnawa <br /> Walk,Hillsborough,NC 27278 City Hillsborough State:NC Zip:27278 Department: Health Amount:$4,500 Purpose: Community <br /> Organizer/Interagency Liaison Budget Code(s): Vendor#61440 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑ <br /> No[] Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective Date August 1,2012 Approved by Board Yes❑ <br /> Non Agenda Date: Title of Contract:COIL-Community Organizer/Interagency Liaison <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❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: ����`'^r-- �!'�.-- <br /> Department Director's Signature: Date: ri I jot <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: Date: <br /> Risk Manaeement <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required 1W. Hold <br /> Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: <br /> _Risk Manager's Signature: ff Aw-'~ Date: 4 Z <br /> 4'kz�- 1EM al 1?t <br /> Financial Services <br /> This Contract is conditioned ullon appropriation by the Board of Commissioners Yes❑No[R./ 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: 4,-, � /�� 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 contraci has e n rev' ed and approved by the Attorney as to legal form and suffici ncy: <br /> Attorney's Signature Date: {IL <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes'CNo❑. <br /> This contract has been reviewed and is for signature by the Chair Yes❑NoL;-' <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 120 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />