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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: Cristina Sansone Party/Vendor Contact Person: Cristina Sansone Contact Phone: 919-245-2379 Party/Vendor <br /> Address:Bertland Avenue' City Durham State:NC Zip:27705 Department: Public Health Amount: $1,241 Purpose: Improve <br /> knowledge of safe sexual behavior and to increase in HPV vaccination rates among teens eens Budget Code(s): 10414020-680018 Vendor# <br /> 60833 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New ® Renewal❑ <br /> Amendment ❑ Effective Date September 30,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Teen <br /> Health Advocate <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 /> to-r-13 <br /> Department Director's Signature: __ _ __ Date: <br /> I free or <br /> (Applicable only to hardware/software purchases or related services)This contract has been reviewed and apgrov <br /> Technology Director as to technical content and information technolo <br /> IT Director's S' <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Prefessional; ❑ 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: d <br /> 10�1U <br /> Financial Services <br /> This Contract is conditioned a on appropriation by the Board of Commissioners Yes❑Nov 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 AcJt`:�� <br /> Financial Services Director's Signature: � (�'' �� ✓ ° - Date: <br /> io(to <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 by Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has be vie e and approved by the Attorney as to legal form and sufficient <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and 's a rov by the County anage r Yes o❑. <br /> This contract has been reviewe is s' ture the it ❑No❑. <br /> Manager's Signature: Date: 0 <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 />