R 2013-261 Health - Cristina Sansone to Improve knowledge of safe sexual behavior and to increase HPV Vaccination rates among teens $1,020

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A013-W# 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: Cristina Sansone Party/Vendor Contact Person: Cristina Sansone Contact Phone: 9A-245- 79 Party/Vendor Address: Bertland Avenue' City Durham State:NC Zip: 27705 Department: Public Health Amount: 1 urpose: Improve knowledye of safe sexual behavior and to increase in HPV vaccination rates among teens eens Budget Code(s): 10414020-680018 Vendor# 60833 (N/A if new vendor) Vendor is a BOCC consultant'? Yes❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date May 1,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Teen Health Advocate 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:7� Date: I irector (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 ❑. Hold Contract pending receipt of Certificate of Insurance ❑. With iocorporation of Insurance provisions as shown,this contract is approved by the Risk Manager: is Signature: ry1 u% Dl �l Date: '7 � /3 Risk Manage g ��'��ir�'��"% � Financial Services This Contract is conditioned u on 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 Fiscal Control Act: PWrY Financial Service�irector's Signature: �^^� F— Oe/�tt(�( D112tate: /�( 13 County Attorney Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC consultant contract). Approval by Manager Or(Most other contracts$1,000 and above). Department Director approval only❑ (Under $1,000). This contract has been rev wed aiud approved by the Attorney as to legal form and suffici ncy. Attorney's Signature Date: County Manager This contract has been reviewed and is approved by the County Manager Y<>o❑. This contract has been reviewed and is for signature by e;C it Yes❑No Manager's Signature: 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