2012-325 Mgr - Chapel Hill Carrboro YMCA Outside Agency $2,000

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ao1�- 8Z5 ! ORANGE COUNTY—CONTRACT CONTROL SHEET Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complete,the ranting process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: Chapel Hill--Carrboro YMCA/Boomerang Program Party/Vendor Contact Person: Laura Short Contact Phone: 919-4424642 Party/Vendor Address:980 Martin Luther King,Jr.Blvd City Chapel Hill State:NC Zip:27514 Department:Outside Agency Amount:$2,000 Purpose:Outside Agency Budget Code(s): 10495050-719047 Vendor#800057 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective Date 07/01/2012 Approved by Board Yes®No❑ Agenda Date:06/19/2012 Title of Contract:2012-13 Outside Agency Performance Agreement If this is a Grant Agreement,pre-application has been approved b I Board of Commissioners Yes❑No❑. If submitted for bid were bids/RFPs received Yes❑No❑ Bid/RFP number This co tct has been reviewed and approved by the Department Director as to technical content: Department Director's Signature: r Date: &,,.,,. 1 7 f 2 IT . ctor (Applicable only to hardware/software purchases or rel e services is contract has been reviewed and approved by the Information Technology Director as to technical content and informati technology specifications: IT Director's Signature: Date: Risk Mana ement Include the following coverages: [RCGL; [Auto; WC; El Property; OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance[With incorporation of Insurance provisions as shown,this contract is approved by the Risk Manager: Risk Manager's Signature: ^�G� N 1 � -- Date: Z- �.st..c.. Financial Services This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[c�. A budget amendment is necessary before approval Yes❑NoN.If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Financial Services Director's Signature: v �j Date: County Attorney Approval by Board A (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant contract). Approval by Man a r❑ other contracts). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorney's Signature Date: 1 Z.... County Manager This contract has been reviewed and is approved by the Co ty Manager Y No❑. This contract has been reviewed and is t submitted B consideration YeMo❑ Manager's Signature: Date: Clerk to the Board Approved by BOCC on the_day of 20 Submitted for Chair signature on the_day of ,20 Clerk's Signature: Date: Revised April 2010