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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: El Futuro Party/Vendor Contact Person: David L. Smith,M.D. Contact Phone: Party/Vendor Address: <br /> 136 E.Chapel Hill St. City Durham State:NC Zip: 27701 Department: Finance and Administrative Services Amount: $27,500 <br /> Purpose: Outside Agency Budget Code(s): 10495050-719049 Vendor#57915 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date July 1,2013 Approved by Board <br /> Yes®No❑ Agenda Date: June 18,2013 Title of Contract: 2013-14 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: J f <br /> Department Director's Signature: Na" Date: <br /> IT Director <br /> (Applicable only to hardwarelsoftware 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 Manazement <br /> Include the following coverages: CR"CGL; [ /Auto; ®'WC; [Professional; ❑ Property; OR No Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance FT With incorporation of Insurance provisions as shown, this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: C' 4_ t� A � Date: 0���,� <br /> Financial Services <br /> This Contract is conditioned u on 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 and Fiscal Control Act: <br /> r' a <br /> Financial Services Director's Signature: t,�- Date: t <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 by Manager[(Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has been r 'ewe d pproved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: 14 15 <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 Ch it Yes❑No <br /> Manager's Signature: Date: 2,4 X13 <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 />