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(j� ORANGE COUNTY-CONTRACT CONTROL SHEET <br /> Routing der: (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: Club Nova Party/Vendor Contact Person: Tracy Bethel Contact Phone: 919-968-6682 Party/Vendor Address: <br /> 103-D West Main Street City Carrboro State:NC Zip:27510 Department: Outside Agency Amount: $75,000 Purpose: Outside <br /> Agency Budget Code(s): 10495050-719048 Vendor#805426 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® <br /> Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 07/01/2012 Approved by Board Yes®No❑ <br /> Agenda Date: 06/19/2012 Title of Contract:2012-13 O tside Agency Performance Agreement <br /> If this is a Grant Agreement,pre-application has be a p oved by the Board of Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes❑No❑ m Bid/RFP nu r This contract has been reviewed and approved by the Department Director as to <br /> technical content: n <br /> Department Director's Signature: a L) D '� <br /> T 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 informatio technology specificat, <br /> IT Director's Signature: Date: <br /> Risk Manage t <br /> Include the following coverages: [Vf CGL; Rf Auto; W WC; W Professional; ❑ Property; ❑ OR No Insurance Required El. Hold <br /> Contract pending receipt of Certificate of Insurance ff. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: n� Q Q <br /> Risk Manager's Signature: ( C'Ww Date: Z- <br /> - . . 81a1 lz <br /> Financial Services <br /> This Contract is conditioned pon appropriation by the Board of Commissioners Yes No A budget amendment is necessary <br /> before approval Yes❑NoM. 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 a d Fiscal Control Act: I <br /> Financial Services Director's Signature: Date: y 1 Z <br /> �,/ County Attorney <br /> L�. <br /> Approval by Board (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Mana er ❑ (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: t �Z <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yeso No❑. <br /> This contract has been reviewed and is to be submitted for BOCC consideration YespNo❑. <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 April 2010 <br />