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00 11E�— 117� <br /> ORANGE COUNTY—CONTRACT CONTROL SHEET <br /> Routing Order: (l)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: Kevin Kirk Party/Vendor Contact Person: same Contact Phone.. PartyNendor Address:5311 Beaumont <br /> Drive City Durham State:NC Zip: 27707 Department:Aging Amount: $ 0 000.0 ose: Instructor Budget Code(s):29430320- <br /> 630000 Vendor#34783 (N/A if new vendor) Vendor is a BOCC cons es❑No® Contract Type:(Check one)New❑ <br /> Renewal ® Amendment ❑ Effective Date July 1,2013 Approved by Board Yes❑No❑ Agenda Date: Title of <br /> Contract: Wellness Instructor <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 number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: vl .27`,(3 <br /> IT Director <br /> (Applicable only to hardwarefsoftware 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 Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required e 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 /> � . <br /> Risk Manager's Signature: Date: J 1 I y <br /> 7a� . to 1 ze3 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No2/ A budget amendment is necessary <br /> before approval Yes❑ Nolf. 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 t-, ��r - Date: I <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval by Manager IkMost other contracts$1,000 and above). Department Director approval only❑(Under <br /> S 1,000). This contract has bee viewed d approved by the Attorney as to legal form and suffici n y: <br /> Attorney's Signature Date: <br /> Count Countv Manager <br /> This contract has been reviewed and is approved by the Coun Manager YesRPsIo❑. <br /> This contract has been reviewed and is for signa a' Yes❑No "` <br /> � <br /> Manager's Signature: [Date: —3- <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 />