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Ara$, <br /> a3� 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: Toni Campbell Shaw Party/Vendor Contact Person: same Contact Phone: Party/Vendor Address: 5510 <br /> Field View Road City Mebane State:NC Zip:27302 Department:Aging Amount P ose: Instructor Budget Code(s): <br /> 29430320-630000 Vendor#61838 (N/A if new vendor) Vendor is a BOCC co su�lta es❑No® Contract Type: (Check one) <br /> New❑ Renewal® Amendment ❑ Effective Date July 15,2013 Approved by Board Yes❑No❑ Agenda Date: Title <br /> of 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: 7-/0-/3 <br /> IT Director <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 Management <br /> Include the following coverages: E] CGL; ❑ Auto; E] WC; El Professional; El 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: <br /> Risk Manager's Signature:�(,h,i(A�li✓ A � Date: /fY <br /> Financial Services <br /> This Contract is conditioned von appropriation by the Board of Commissioners Yes❑Nov 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 Bu et and Fiscal Controll ct: <br /> ' Signature: �'�'�'�"� �"' A*--� Date: L� <br /> Financial Services Director's <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 z (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has bee eview a d approved by the Attorney as to legal form and suffici ncy: <br /> • Date: Ic I E7 I3 <br /> Attorney's Signature <br /> County Manager <br /> This contract has been reviewed and is approved by the County anager Yes[ io❑. <br /> This contract has been reviewed and is for signat y th rs[-]No <br /> Manager's Signature: Date: <br /> le k o 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 />