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.C�O 1-4--3 1 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: Lorraine Lewis Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: 10.3 Jones <br /> Ferry Road,Suite H City Carrboro State:NC Zip:27510 Department:Aging Amount: $2,000.00 Purpose: Wellness Class Budget <br /> Code(s):29430320-630000 Vendor#57608 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No[�] Contract 1-\pe: <br /> (Check one)New❑ Renewal ® Amendment ❑ Effective Date 7/01/14 Approved by Board Yes❑No❑ Agenda Date: <br /> Title of 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: V/'Ad/S< <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 s q tltc�tt i i; alp d <br /> by the Risk Manager: U (5 a <br /> Risk Manager's Signature: �_ Date: JUN 2 <br /> l.Ptz� <br /> Financial Services By_ <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No� A u gefPli'titimtt is <br /> before approval Yes❑No[ . 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 Budg t nd Fiscal Control ct: <br /> Financial Services Director's Signature: G�^�•L✓ ♦ 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 b nagerg(Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has been vi ed and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager / <br /> This contract has been reviewed and is approved by the County Manager Yes[E' ❑. <br /> This contract has been reviewed and isor signature by the Chair No❑. <br /> Manager's Signature: < '9 y ' 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 />