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i <br /> 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: Martha Broda Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 1388 Mans <br /> Chapel Road City Pittsboro State:NC Zip:27312 Department:Aging Amount: $3,000.00 Purpose: Wellness Classes Budget Code(s): <br /> 29430320-630000 Vendor#58627 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one) <br /> New❑ Renewal® Amendment ❑ Effective Date 07/04/14 Approved by Board Yes❑No❑ Agenda Date: Title of <br /> Contract:Wellness Instructor <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: i-/9—& <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 showr <br /> by the Risk Manager: //11 D <br /> Risk Manager's Signature: 4�_� (.,cw�,�"6.e�'� Date: { <br /> t�lz3 JUN 2 0 2014 <br /> Financial Services 7::PPIl <br /> This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑Noo� A budg <br /> before approval Yes[]NovIf budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the <br /> manner required by the Local Government Bud et and Fiscal Control Act: <br /> Financial Services Director's Signature: C q,^ AAL,� Date: <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 Manager[ (Most other contracts$1,000 and above). Department Director approval only❑(Under <br /> $1,000). This contract has been re ewed an approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: b ZS <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes 00. <br /> This contract has been reviewed and is for signature by the Chair Yes❑No❑. <br /> Manager's Signature. Date: <br /> Clerk tot a 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 /> I <br /> i <br /> Revised March 2012 <br /> I <br /> I <br />