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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: Charles House Party/Vendor Contact Person: Paul Kever Contact Phone: Party/Vendor Address: 109 <br /> Hillcrest Ave. City Carrboro State:NC Zip: 27510 Department: Finance&Administrative Services Amount: $15,000 Purpose: <br /> Outside Agency Budget Code(s): 10495050-710029 Vendor# 800031 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑ <br /> No® Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date July 1,2013 Approved by Board Yes®No <br /> ❑ Agenda Date: June 18,2013 Title of Contract: Outside Agency Performance Agreement <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: ` A � Date: <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 Man ement <br /> Include the following coverages: RrCGL; [f Auto; Y 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: t/t ''1�U"�� Date: I� <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[V A budget amendment is necessary <br /> before approval Yes❑ No I 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 and Fiscal Control Act: <br /> a "Financial Services Director's Signature: C� �% A AV, Date: 49/0 <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 b anager[(Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has been e 'ew approved by the Attorney as to legal form and suffi ienc : <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes❑No❑. <br /> This contract has been reviewed and is for signature by the Chair YesFL1NoF1 <br /> Manager's Signature: Date: <br /> Clerk 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 />