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ORANGE COUNTY—CONTRACT CONTROL SHEET <br /> Routing Order: (7)Department,(Z)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 for8OCC approval. Contracts for <br /> 8OCC approval must be submitted tbnuo8k and complete,the routing process prior tn agenda review. Contracts for legal review should <br /> beuwmp\etodtbrnughtbelogu{rcvimvvpn�oampr�rtoheiogr*�ed�rsignature. <br /> Department <br /> Partv'Vendor Name: Janice Galloway Party/Vendor Contact Person: Same Contact Phone. <br /> . )_ Party/Vendor Address:6615 Glen <br /> Forest Drive City Chapel Hill State:NC Zip: 27517 Department:Aging Amo $8 Purpose:Fit Feet Nurse Budget Code(s): <br /> 29430320-622000 Vendor# 58613- (K/—A if new vendor) Vendor is a BOCC Yes E]NoZ Contract Type:(Check one) <br /> New M Renewal [9 Amendment n Effective Date July 1,2013 Approved by Board Yesn Non Agenda Date: Title of <br /> Contract: Wellness Instructor <br /> If this ioa(Grant Agreement,pre-application has been approved by the Board nf Commissioners YuonNon. lf submitted for bid were <br /> bida/RFPa received YeuFlNoFl Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: <br /> IT Director <br /> (Applicable only/o6u,dwuru6oftwore purchases o/related services)This contract has been reviewed and approved hy the Information <br /> Technology Director usko technical content and information technology specifications: <br /> IT Director's Signature: Date: <br /> Risk Manaaement <br /> |nc|ude the following coverages: Fl CGL; n Auto; Fl WC; n9rofeomkmo|; Fl Property; OR Hold <br /> Contract pending receipt n[Certificate ofInsurance With incorporation of Insurance provisions as shown,this contract is approved <br /> h) the Risk Manager: <br /> Risk Manager's Signature: Dat : � <br /> Z^s--^ L.I M <br /> Financial Services <br /> This Contract is conditioned qpon appropriation by the Board ofCommissioners `ycmnNo[z A budget amendment is necessary <br /> before approval YeoD |No[7 1f budget amendment io necessary, please attach io this form. This instrument has been pre-audited bnthe <br /> manner required hy the Local Government Budget and Fiscal Co l ct: <br /> Financial Services Director's Signature: Date: <br /> County Attorney <br /> Approval by Board Fl (Contracts $00000 or more for goods or services, $250,000.00 or more for construction, or any DOCC <br /> consultant ) ] . Department Director approval only[](Under <br /> $}`OOO). This contract has bee eview approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: � <br /> County Manne <br /> [bix contract has been reviewed and is approved by the County Manager l'cvENoFl. <br /> Tbiacontract Fl [:�, <br /> Manager's Signature: Date: 7 <br /> Clerk 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 March 2012 <br />