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X13_ 14(c <br /> 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: Ama Champong Party/Vendor Contact Person: Ama Champong Contact Phone:919.929.8800 Party/Vendor <br /> Address:2701 Homestead Road Apt 309 City Chapel Hill State:NC Zip:27516 Department:HEALTH Amount: $900.00 Purpose: <br /> Assist with Smoke-Free Public places Policy and Promotion Budget Code(s): 10412020-630000 Vendor#N/A (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 4/1/13 <br /> Approved by Board Yes[:]No❑ Agenda Date: Title of Contract:A.ACHAMPONG <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❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: tZ Date: <br /> IT Director <br /> (Applicable only to har tware purchases or related servic ' contract has been reviewed and approved by the Information <br /> Technology Director as to technical 1 I o ri I tiit i I i d info echnology specifications: <br /> IT Director's Signature: Date: <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required Q/ 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: l/� W .� y Date: 1 2 f 3 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[d A budget amendment is necessary <br /> before approval Yes❑NoN.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: 6&,., /� a�/�'� 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 a revie d approved by the Attorney as to legal form and suffic' ncy: <br /> Attorney's Signature Date: ql_=4 13 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager s N <br /> This contract has been reviewed and is for signature by Chair Yes❑No <br /> Manager's Signature: Date: <br /> Cler to oard <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 March 2012 <br />