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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?C'Jerk <br /> This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specifiec.above. I I 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: Charles House Association Party/Vendor Contact Person: Paul Klever Contact Phone:—_ Party/Vendor <br /> Address: 109 Hillcrest Ave City Carrboro 48tate:NC Zip:27510 Department:AeiU Amount: $5,000.00 Purpose:R_ espite C dire <br /> Budget Code(s): 10432020-630100 Vendor# 19446 (N/A if new vendor) Vendor is a BOCC consultant? Yes El NoZ 1_'ontract <br /> Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date 7/01/14 Approved by Board Yes❑ No❑ A enda Date: <br /> Title of Contract:Caregiver Respite <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: VCGL; [Auto; WC; Professional; ❑ Property; OR No Insurance Reauit'ed D. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions ai-sh <br /> {� c 7.11..a oved <br /> by the Risk Manager: <br /> U ) , <br /> Risk Manager's Signature: Date: U 2.'3 2 <br /> L.V1 z4 <br /> Financial Services _ <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[d E �ent*� sary <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: �wL�1i►.�, .✓• AA-4— Date:� I <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,0001- 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approva by anager (Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has bee ewed and approved by the Attorney as to legal form and sufficie cy.:r' <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YesE No❑. <br /> This contract has been reviewed and is for signature by the Chair Yes❑No❑. <br /> Manager's Signature: '� Date: ? <br /> r <br /> i <br /> Clerk to the Board <br /> Approved by BOCC on the_day of ,20 . Submitted for Chair signature on the_day o f 20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />