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E»"&I!9f -0 Od3ae, I % �( �g*, l3�Ha#AeT <br /> outing r er: (1) epartmen, s c g en, mancia ervices, orney, a er,l tl er <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:40411INFAIRM,19ri hg t Starve Party/Vendor Contact Person: A��taacct Phone: Party/Vendor Address: <br /> City State: Zip: Department: Library Amount: `_�s rurpose: Programming Budget Code(s): <br /> 10500020-630000 Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one) <br /> New® Renewal ❑ Amendment ❑ Effective Date Approved by Board Yes❑No® Agenda Date: Title of <br /> 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 num This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signat re: Date: /D <br /> Di ct r <br /> (Applicable only to hardware/softwar purchases or related ervice is contract has been reviewed and approved by the Information <br /> Technology Director as to technical content and information techno ogy specifications: <br /> IT Director's Signature: Date: <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ 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: j , <br /> Risk Manager's Signature: V -C� r �� Date: �l Z <br /> Financial Services <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No®. 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 Contr l Act <br /> Financial Services Director's Signature: Ua,(I— sl :�,_ 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). Approval by Manager❑(Most other contracts$1,000 and above). Department Director approval only® (Under <br /> $1,000). This contract has bee viewed and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes❑No®_ . <br /> This contract has been reviewed and is for signature by the Chair Yes❑No®. <br /> Manager's Signature: I .. Date: <br /> Clerk t the Board <br /> Approved by BOCC on the_day of ,20 Su 'fitted for Chair signature on the day of ,20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />