R 2013-213 Aging - Charron Andrews for Instructor for Balance classes at the Seymour Center

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X13— Zl3 ORANGE COUNTY—CONTRACT CONTROL SHEET Routing Order: (1) Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: Charron Andrews Party/Vendor Contact Person: same Contact Phone: P ndor Address: 108 Cottonwood Court City Chapel Hill State:NC Zip:27514 Department: Aging Amount: 1,0 Purp Instructor Budget Code(s): 29430320-630000 Vendor#38424 (N/A if new vendor) Vendor is a BOCC�ofi tare- s No® Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1,2013 Approved card Yes❑No❑ Agenda Date: Title of Contract: Wellness Instructor If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted for bid were bids'RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: Department Director's Signature: Date: (o-aT/3 IT Director (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Management Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required dHold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved by the Risk Manager: Risk Manager's Signature: -'��^t✓ /�/ ''� Date: t 3 Financial Services this Contract is conditioned ppon appropriation by the Board of Commissioners Yes❑No[/ A budget amendment is necessary before approval Yes❑ NoIf budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Financial Services Director's Signature: a4l-� /�' Date: I NIS County Attorney Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or an BOCC consultant contract). Approval by Manager❑ (Most other contracts$1,000 and above). Department Director approval only (Under $1,000). This contract has been r *ewe nd approved by the Attorney as to legal form and suffi ienc : Attorney's Signature Date: County Manager fhis contract has been reviewed and is approved by the County anager Ygs This contract has been reviewed and is for sig by C ❑No g er Mana g 's Signature: v Date: Clerk to the Board Approved by BOCC on the_day of ,20 . Submitted for Chair signature on the_day of 20 Clerk's Signature: Date: Revised March 2012