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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: El Centro Hispano Party/Vendor Contact Person: Pilar Rocha-Goldberg Contact Phone:919-687-4635 <br /> Party/Vendor Address:600 East Main Street City Durham State:NC Zip:27001 Department: Outside Agency Amount: $17,000 <br /> Purpose:Outside Agency Budget Code(s): 10495050-719058 Vendor#801399 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes❑NoZ Contract Type: (Check one)New 23 Renewal❑ Amendment ❑ Effective Date 07/01/2012 Approved by Board Yes <br /> ED No❑ Agenda Date:06/19/2012 Title of Contract:2012-12 Outside Agency Performance Agreement <br /> If this is a Grant Agreement,pre-application has been ap <br /> proved by the Board of Commissioners YesF]No❑. If submitted for bid were <br /> This <br /> bids/RFPs received Yes❑NoF] Bid/RFP nurn r s contract has been reviewed and approved by the Department Director as to <br /> technical content: Bid/RFP This contract has been <br /> Department Director's Signature: — Date: <br /> .�� - rz-- <br /> Direc r <br /> (Applicable only to hardwarelso rchases or relate ervices)This c ct has been reviewed and approved by the Information <br /> !f;: <br /> Technology Director as to technical content and information technology specifications: <br /> IT Director's Signature: Date: <br /> Risk Mataiientent <br /> Include the following coverages: 12(CGL; [Auto; [WC; [4 Professional; ❑ Property; ❑ OR No Insurance Required El. 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:A44,t., J/U-j Date: 241 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners YesE]No[E/ A budget amendment is necessary <br /> . If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the <br /> before approval YesE]NoV <br /> manner required by the Local Government Budget and Fiscal Control Act: <br /> Financial Services Director's Signature: _Date:__9LZ4 <br /> County Attornev <br /> Approval by Board A(Contracts over $90,000.00 for goods or services, $250,000-00 for construction, or any BOCC consultant <br /> contract). Approval by Mana e ❑ (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> Attorney's Signature Date: IL <br /> County Manaeerl <br /> This contract has been reviewed and is approved by the County Manager Yes 23-Nrn. <br /> This contract has been reviewed and is considers iRonVesQNOFT <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 20 <br /> Clerk's Signature: Date: <br /> Revised April 2010 <br />