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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: EmPOWERment Party/Vendor Contact Person: Delores Bailey Contact Phone:919-967-8779 Party/Vendor <br /> Address: 109 N.Graham Street City Chapel Hill State:NC Zip:27516 Department:Outside Agency Amount:$13,000 Purpose: <br /> Outside Agency Budget Code(s): 10495050-789005 Vendor#800065 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑ <br /> No® 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 Outside Agency Performance Agreement <br /> If this is a Grant Agreement,pre-application has been approved by t1A Board Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes❑No❑ Bid/RFP number This con t h be n reviewed and approved by the Department Director as to <br /> technical content: h <br /> Department Director's Signature: Date: <br /> IT UDctor <br /> (Applicable only to hardware/software purchases or related services)T is 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 JVI ca cement <br /> Include the following coverages: [dCGL; dAuto; Risk <br /> C� Professional; ❑ 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: I n S;Waj,,L- G&t b4t - N <br /> Risk Manager's Signature: � � ,U, "� Date: h 9!f <br /> 1 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[31" 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 /> Financial Services Director's Signature: UL�, •e ,.f/, /'� Date: a J/!2 <br /> County Attorney <br /> Approval by Board V(Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Manager ❑ (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: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YNo❑. <br /> This contract has been reviewed and is to be submitted for BOCC consideration Ye NOW <br /> r _ <br /> Manager's Signature: '� � Date: <br /> erk 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 />