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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: Triangle J Council of Governments Area Agency on Aging Party/Vendor Contact Person: Joan Pellettier Contact <br /> Phone:919-558-9398 Party/Vendor Address:4307 Emperor Blfd., Suite 110 City Durham State:NC Zip:27703 Department:Aging <br /> Amount: $490,460 Purpose:Home and Community Care Block Grant Budget Code(s): 10430120&10432020 Vendor#5855 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Che one)New❑ Renewal® Amendment ❑ <br /> Effective Date 07/01/13 Approved by Board Yes No❑ Agenda Date:�itle of Contract:AA. -eement for Provision of <br /> County-Based Aging Services <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: 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 Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ 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: LnUU�11 L a L'l T <br /> Risk Manager's Signature: Date: � R - 4 214-x+171��+ Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[/ A bment is necessary <br /> before approval Yes❑No[VIf budget amendment is necessary,please attach to this form. This instrum1173S MT11 <br /> manner required by the Local Government Budget and (J <br /> d Fiscal Control Act: �J <br /> Financial Services Director's Signature: �ay"t., ,, . A-.4— Date: f ' <br /> County Attorney <br /> Approval by Board N (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 bee revie and approved by the Attorney as to legal form and suffici nc : <br /> Attorney's Signature Date: $ 14 <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 Chair 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 /> Revised March 2012 <br />