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ZOLA- 25 1°i <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 /> Party/Vendor Name: Diana Montgomery Party/Vendor Contact Person: SAME Contact Phone:919- Party/Vendor Address: 1830 <br /> Halls Mill Rd.,Efland NC 27243 City Hillsborough State:NC Zip:27278 Department: Health Amount:$4,500 Purpose: Community <br /> Organizer/Interagency Liaison Budget Code(s): Vendor#61441 (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 /> No❑ 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❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date:83. <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 Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required [d Hold <br /> Contract pending receipt of Certificate of Insurance M. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: v��^�^ `"` Date: D 12 <br /> Financial Services <br /> This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑Nog. 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 /> Financi al Services Director's Signature: �. Date: 2 <br /> County Attornev <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 contract has be eview a approved by the Attorney as to legal form and su fic' ncy <br /> Attorney's Signature Date: ? 24 f& <br /> County Manager <br /> This contract has been reviewed and is approved b the Co ty Manager Yes�No❑. <br /> This contract has been reviewed and is far, a re y air Yes❑Noa. <br /> Manager's Signature: Date: _ Z f <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 March 2012 <br />