Orange County NC Website
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: Lorraine Lewis Party/Vendor Contact Person: same Contac o e:_� Party/Vendor Address: 104 Jones <br /> Fern Rd. City Carrobor State: NC Zip:27510 Department:A in Amount: 0 0 Purpose: Instructor Budget Code(s): <br /> 29430320-630000 Vendor#60912 (N/A if new vendor) Vendor is a BOC onsult rf? Yes❑No❑ Contract Type:(Check one) <br /> New ❑ Renewal ® Amendment ❑ Effective Date July 1,2013 Approve b and 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 forbid 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: 6-,27­0 <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: ❑ 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: y' <br /> Risk Manager's Signature: �'�"�^� f' � '`` Date: I <br /> Financial Services <br /> This Contract is conditioned ypon 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 Budget, Fiscal Control Act: <br /> Financial Services Director's Signature: tY iLl Lw 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 an 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 b rev ewqdand approved by the Attorney as to legal form and suffi iency: <br /> Attorney's Signature Date: �3 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes' ]�I�e❑ <br /> This contract has been reviewed and is for signature by the C i Yes❑No�! <br /> ———————————-L�P�Q C F) <br /> �` -ZNl <br /> Manager's Signature: Date <br /> i <br /> &rk 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 />