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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: UNC Center for Health Promotion and Disease Prevention Party/Vendor Contact Person: Cherie Rosemond <br /> Contact Phone: Party/Vendor Address: 104 Airport Rd Ste 2200 CB#1350 City Chapel Hill State:NC Zip:27599-1350 <br /> Department: Aging Amount: $14,900.00 Purpose:MAP Housing Study Budget Code(s): 10430020-630120 Vendor# 10419 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New❑ Renewal® Amendment ❑ <br /> Effective Date 07/01/14 Approved by Board Yes[]No❑ Agenda Date: Title of Contract:MAP Housing Study <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: W <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 Re u� fired ❑. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as show COW , rM <br /> by the Risk Manager: I LI U <br /> Risk Manager's Signature: (iGC.�- �.J �� x4--- Date: i JUN 2 4 2014 <br /> l.olz3 �� <br /> Financial Services B v <br /> This Contract is conditionepon appropriation by the Board of Commissioners Yes❑No A budget amen en <br /> before approval Yes❑NoM. 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: Date: Z �� <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 by Manag Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has been reviewed appr ved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: 1� <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 jam'signa 4ire by the Chair Yes❑No❑. <br /> Manager's Signature: r <br /> `2��'� �,, _ 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 />