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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: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone:919-967-7570 <br /> Party/Vendor Address: 109 Hillcrest Ave City Carrboro State:NC Zip:27510 Department:Outside Agency Amount: $12,000 <br /> Purpose:Outside Agency Budget Code(s): 10495050-710029 Vendor#800031 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes❑No[D 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 been approved by the Board of Commissioners Yes❑Non. If submitted for bid were <br /> bids/RFPs received Yes❑Non Bid/RFP number This ontract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: 0 F Datl'9—41.12 <br /> _Di ct <br /> 77 <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 Manazement <br /> Include the following coverages: EYCGL; [J Auto; ; [professional; 2 Property; ❑ OR No Insurance Required El. 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: ( h tt?- <br /> Financial Services <br /> This Contract is conditioned vf)on appropriation by the Board of Commissioners YesE]Noo/ A budget amendment is necessary <br /> before approval YesEl [I. 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:_ya^z, ,/� A_,� Date: <br /> County Attorney <br /> Approval by Board [t (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&at Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes OF1 <br /> This contract has been reviewed and is to be submitted for BP C consideration Ye'NoR. <br /> Manager's Signature: VI <br /> Date: <br /> CIrk to the Board <br /> Approved by BOCC on the day of 120 Submitted for Chair signature on the day of 120 <br /> "F'v' <br /> Clerk's lerk's Signature: Date: <br /> Revised evised April 2010 <br />