R 2013-417 Health - Kevin Kirk to Teach the exercise Component $600

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ORANGE COUNTY—CY.?i\TR,/i.CT CONTROL SHEET Routing Order: (1)Department, (2)IT, (3)Risk Mana,, ,Y.nt (•i Financial Services,(5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be suhmittec; for sign-.tture in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the ;Vdanager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complctc,the,1(7.6 ii)_, roc,;s3 prior to agenda review. Contracts for legal review should be completed through the lega<' ceve x process prior to being routed for signature. Department Party/Vendor Name: Kevin Kirk Party/Vendor Contact Person: Kevin Kirk Contact Phone: Party/Vendor Address: 5311 Beaumons Drive City Durham State:NC Zip: 27707 Department: Public Health Amount: $600 Purpose: Teach the exercise component Budget Code(s): 30412020-630000 Vendor#34783 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date July 1,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: DSME-Kirk If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted for bid were bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: Department Director's Signature: ~ _._ Date:_ 13 IT rector (Applicable only to hardware/software purchases or related sci vices) 1 iris contract has been reviewed and approved by the information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Manazement Include the following coverages: t<CGL; ❑ Auto; ❑ WC; �?Professional; ❑ Property; OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown this contract . approved by the Risk Manager: v r��C AeV_ kR%3 WQ,,. Risk Manager's Signature: _ �� , —r Date: gl.zz L� Financial Services This Contract is conditioned Won appropriation by the Board of Commissioners Yes❑No[V A budget amendment is necessary before approval Yes❑No[1If budget amendment is necessary, please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Financial Services Director's Signature: t44vt✓ Date: Z S IV �3 ConnG Attorney Approval by Board ❑ (Contracts $90,000.00 or more for good-, or servicrs, $250,000.00 or more for construction, or any BOCC consultant contract). Approval by Manager (Most cth_,r cciutracis.S 1.000 and above). Department Director approval only❑ (Under $1,000). This contract has bee vie a d approved b tin. Attuun;y as to legal form and sufficiency: Attorney's Signature Date: 1 County Manager This contract has been reviewed and is a ro by the County, anager Yes o❑. This contract has been reviewed a s o sign ure b he r es❑No❑. Manager's Signature: Date:444� Clerk to the Board Approved by BOCC on the_day of 20!_. Submitted for Chair signature on the_day of 20 Clerk's Signature: Date: Revised March 2012