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ac�13_ a5 <br /> ORANGE COUNTY-CONTRACT CONTROL SHEET <br /> Routing Order: (I)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 Association Party/Vendor Contact Person: Paul Klever Contact Phone: 919-967-7570 <br /> Party/Vendor Address: 109 Hillcrest Ave City Carrboro State:NC Zip: 27510 Department: DSS Amount: $25.000 Purpose:Adult <br /> Day Services to clients of Orange County Budget Code(s): 10405020-764100 Vendor# 19446 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date 07/01/14 <br /> Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Charles House Association <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: ,2 7y <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 /> Risk Mana ement <br /> Include the following coverages: BYCGL; [Auto; C; rofessional; ❑ 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 /> Risk Manager's Signature: 044V4.., Date: <br /> [17 �3 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary <br /> before approval Yes❑ No V.. 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 nd Fiscal Control Act- <br /> Financial Financial Services Director's Signature: l�C �- /,� /� Date: <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 Maria er X(Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has be r view d d approved by the Attorney as to legal form and sufficiency,- <br /> Attorney's Signature Date: 1 1 <br /> County Manager <br /> This contract has been reviewed and is approved by the C ity Manager Yes o❑. <br /> This contract has been reviewed and is for signature b t air Yes❑No <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 /> vised March 2012 <br />