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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: The Arc of Orange County Party/Vendor Contact Person: Robin Baker Contact Phone:919-942-5119 <br /> Party/Vendor Address:208 N.Columbia Street City Chapel Hill State:NC Zip:27514 Department:Outside Agency Amount:$4,000 <br /> Purpose:Outside Agency Budget Code(s): 10495050-719023 Vendor#50706 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes E]NoN Contract Type:(Check one)New Z Renewal❑ Amendment ❑ Effective Date 07/01/2012 Approved by Board Yes <br /> Z No❑ Agenda Date:06/19/2012 Title of Contract:2012-13 Outside Agency Performance Agreement <br /> If this is a Grant Agreement,pre-application has bee proves, y the Board of Commissioners Yes[]No[:]. If submitted for bid were <br /> bids/RFPs received YesE]NoE] Bid/RFP nu7by,/ hi'contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature:7 aJVf_,1_ Datc�/, O <br /> U I <br /> IT ire <br /> TT or <br /> (Applicable only to hardware/software purchases Wrelat Ldse ces)ire <br /> sc mract 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 MAnaizement <br /> Include the following coverages: CGL; Auto WC; 9Professional; ❑ Property; ❑ OR No Insurance Required ❑. 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: <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑Nolg/ 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 and Fiscal Control Act: <br /> Financial Services Director's Signature: ekm-,� J. Date: I IDJ a <br /> County Attorney <br /> Approval by Board r (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Mana Y ❑ (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: �D I 1-t )z- <br /> County Manaize <br /> This contract has been reviewed and is approved by the County Manager Y Non. <br /> This contract has been reviewed and is to be sub ration Yes 0 <br /> Manager's Signature: Date: <br /> Afll_e�rk 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 />