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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: Community Empowerment Fund Party/Vendor Contact Person: Maggie West Contact Phone: <br /> Party/Vendor Address: 133 1/2 E.Franklin St. City Chapel Hill State:NC Zip:27514 Department: Finance and Administrative <br /> Services Amount: $5,000 Purpose: Outside Agency Budget Code(s): 10495050-719064 Vendor#61695 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date July 1, <br /> 2013 Approved by Board Yes®No❑ Agenda Date: June 18,2013 Title of Contract: 2013-14 Outside Agency Performance <br /> 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: � �" /w� Date: 0 l f 3 <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 /> isk Man ement <br /> Include the following coverages: [111"CGL; Auto; WC; Y 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: � �/ , Date: <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑Noa/ 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 /> Financial Services Director's Signature: ��h.G.. � l�✓i'� Date: LL 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 by Manager 0(Most other contracts $1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has been e ie 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 Coun Manager Yes No❑. <br /> This contract has been reviewed and is for signa by he it Yes❑No <br /> Manager's Signature: Date: y !/ <br /> t <br /> l 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 />