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,�?o1- -�3`7 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: Nancy Dede Banks Party/Vendor Contact Person: same Contact Phone: Party/Vendor Address: 747 Rock <br /> Rest Road City Pittsboro State:NC Zip:27312 Department:Aging Amount: $3,000.00 Purpose:Wellness Class Budget Code(s): <br /> 29430320-630000 Vendor#55776 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one) <br /> New❑ Renewal® Amendment ❑ Effective Date 07/11/14 Approved by Board Yes❑No® Agenda ate: 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: 7-11-1-1 <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 Manaizement <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 pro4ah sV n 1 <br /> by the Risk Manager: 5 L LC <br /> Risk Manager's Signature: ae. P Date: JUL 1 1 Z O 14 <br /> Financial Services This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No <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 and Fiscal Control Act: 04-4 !ZA"im <br /> • �4 <br /> 14 Financial Services Director's Sign ur . ate: <br /> Kee �qw <br /> 0 tt 'a?bR <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval by ager[(Most other contracts$1,000 and above). Department Director approval only❑(Under <br /> $1,000). This contract has been r vo ed and approved by the Attorney as to legal form and suffici ncy: <br /> Attorney's Signature Date: q, <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 it sigma ure by the Chair Yes❑No❑. <br /> Manager's Signature: r Date: <br /> Cler 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 />