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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: Anna Miller Party/Vendor Contact Person: same Contact Phone: Party/Vendor Address: 104 D West <br /> Polar City Carrboro State:NC Zip:27510 Department:Aging Amount: $3,000.00 Purpose:MAP long term care initiative Budget <br /> Code(s): 10430020-630120 Vendor#62470 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: <br /> (Check one)New® Renewal❑ Amendment ❑ Effective Date 05/20/14 Approved by Board Yes❑No® Agenda Date: <br /> Title of Contract:Master Aging Plan <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: d <br /> Department Director's Signature: GtwLC.GC �E Date: <br /> 0 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 I fired Fnl. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as sh ,%&',�ola&Tar v <br /> by the Risk Manager: v UU lJ <br /> Risk Manager's Signature: � 0 0 Date: / MAY 19 2014 <br /> Financial Services By + � <br /> This Contract is conditione4fpon appropriation by the Board of Commissioners Yes No A budget amendment is necessary <br /> before approval Yes[:]NoK 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: (w.4, �• Date: 5 L <br /> 5lzo <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000.6 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 been a UT d by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: s Z� <br /> County Manager <br /> This contract has been reviewed and is a pro ed b e Cou ty Ma ager Yes No❑. <br /> This contract has been reviewed an or na y ha' es o❑. p / <br /> Manager's Signature: Date: O <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 />