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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. I:f 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: Rebecca Sugg Party/Vendor Contact Person: Contact Phone: Party/Vendor Address:`_1'h S <br /> Camellia St City Cha ep 1 Hill State:NC Zip:27516 Department:Agin Amount: $2,000.00 Purpose: Wellness Classes 1 udLet <br /> Code(s): 29430320-630000 Vendor#60912 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No[] Contract I'vpe: <br /> (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/14 Approved by Board Yes❑No❑ Agenda I)ate: <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 Iirector as to <br /> technical content: <br /> Department Director's Signature: A Date: 7/7-/ <br /> IT Director <br /> (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the I n turmation <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 Insurarce Required []? Hold <br /> Contract pending receipt of Certificate of Insurance �qp vc pp <br /> p g p ❑. With incorporation of Insurance provisions as sho t lei L,�ct is a <br /> by the Risk Manager: <br /> Risk Manager's Signature: �Lt fr r� —' Date: JUL 4 <br /> 71 ZI <br /> Financial Services <br /> This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[17�. A bud By,tm�idinerT ts"n <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 Budget andF Control Act: <br /> Financial Services Director's Signature: uxu ✓ A Date: <br /> County Attorney <br /> Approval by Board ❑ (Contrac $90,000. 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval b nager (Most other contracts$1,000 and above). Department Director approval on I ❑ (Under <br /> $1,000). This contract has been vie ed and approved by the Attorney as to legal form and suffic' ncy- <br /> Attorney's Signature Date: <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 for signature by the Chair Yes❑No❑. <br /> Z" / <br /> Manager's Signature: "� Date: ! s <br /> Jerk 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 />