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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: Freedom House Party/Vendor Contact Person: Trish Hussey Contact Phone: Party/Vendor Address: 104 <br /> New Stateside Dr. City Chapel Hill State: NC Zip: 27516 Department: Finance&Administrative Services Amount: $29,000 Purpose: <br /> Outside Agency Budget Code(s): 10495050-710037 Vendor# 800030 (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:_ ^-� �. ! 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 /> ask Mat ement <br /> Include the following coverages: E3/CGL; [,/] Auto; ff WC; E9 Professional; ❑ Property; OR No Insurance Required El. 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 /> l� G <br /> Risk Manager's Signature: "` u l� dw, Date: <br /> Financial Services <br /> This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑NoD?/ A budget amendment is necessary <br /> before approval Yes❑NoZ. 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 J Control�Act: <br /> Financial Services Director's Signature: qal-t"w 'j, AV" Date: 01 <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000. 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval Manager[(Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has bee r vie ed d approved by the Attorney as to legal form and sufficiency: <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 es❑No <br /> Manager's Signature: Date: <br /> Cler to the Board <br /> Approved by BOCC on the_day of f ,20 . Submitted for Chair signature on the_day of 20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />