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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: UNC Center for4fealth Promotion and Disease Prevention Party/Vendor Contact Person: Cherie Rosemond <br /> Contact Phone:919-906-9334 P4rtyNen or dress: 1700 MLK Jr Blvd,CB 7426 City Chapel Hill State:NC Zip:27599-7426 <br /> Department: Aging Amount: $9 100.0 P os :MAP Study Budget Code(s): 10430020-630120 Vendor# 10419 (N/A if new vendor) <br /> Vendor is a BOCC consults Yes o® Contract Type:(Check one)New® Renewal❑ Amendment E:1 Effective Date July <br /> 22,2013 Approved by Bo d No❑ Agenda Date: Title of Contract: MAP Housing Study <br /> If this is a Grant Agreeme -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: Date: 7 Z4-/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 Mana¢ement <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: <br /> Risk Manager's Signature: �j OFPW'a 1))*tMA Date: <br /> Financial Services <br /> This Contract is conditioned u 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 Bu and Fiscal Control Act: <br /> Financial Services Director's Signature: ;,x 'h l� Date: ? Z2 3 <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 E] (Under <br /> LA$1,000). This contract has be reviewed and approved by the Attorney as to legal form and suffic'ency: <br /> Attorney's Signature /" ` Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the Counly Manager Yes;2No❑. <br /> This contract has been reviewed and is for nature by the Chair YesE]NoLiK <br /> ,j Manager's Signature: Date: <br /> erk 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 />