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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: Kevin Kirk Party/Vendor Contact Person: Kevin Kirk Contact Phone: Party/Vendor Address:5311 <br /> Beaumons Dr. City Durham State:NC Zip:27707 Department: Health Amount: $600.00 Purpose: Teach Exercise Component of <br /> Group Instruction for DSME Program Budget Code(s): 30412020 630000 71105 Vendor#34783 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes F-1 NoZ Contract Type: (Check one)New F-1 Renewal Z Amendment ❑ Effective Date July 1,2012 <br /> Approved by Board Yes❑No❑ Agenda Date: Title of Contract: <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: <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; F-1 WC; r_1 Professional; ❑ Property; OR No Insurance Required e 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: Date: 24/12- <br /> p5nx:7. a I 141 tz <br /> This Contract is conditioned Financial Services 12( <br /> conditioned appropriation by the Board of Commissioners Yes[jNo A budget amendment is necessary <br /> before approval Yes❑No[V1. 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: d6v�� A. A114— '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). roy by Manager[(Most Most other contracts$1,000 and above). Department ❑Director approval only F I (Under <br /> t has <br /> $1,000). This contract rev and approved by the Attorney as to legal form and sufficl cy: <br /> , -Z.�( -L, <br /> Attorney's Signature Date: r_4 r <br /> County Manner <br /> This contract has been reviewed and is approved by the County Manager YqsFfNof_1. <br /> This contract has been reviewed and is YesE]NpE;J�. <br /> .,o-Z-/ <br /> Manager's Signature: 34 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 March 2012 <br />