R 2014-373 Aging - Functional Fitness, LLC for wellness class

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ORANGE COUNTY—CONTRACT CONTROL SHEET Routing Order: (1)Department,(2)IT,(3)Risk Management, (4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC alproval. Contracts for BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: Functional Fitness,LLC Party/Vendor Contact Person: Kevin Kirk Contact Phone: Party/Vendor Address: 5311 Beaumont Drive City Durham State:NC Zip:27707 Department:Aging Amount: $14,990.00 Purpose:Wellness Class Budget Code(s):29430320-630000 Vendor#34783 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/11/14 Approved by Board Yes❑No® Agenda Date: Title of Contract:Wellness Instructor If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No[]. If;submitted for bid were bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: AA Department Director's Signature: Date: IT Director (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approve by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Management Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions 4sho ,ism y by the Risk Manager: Risk Manager's Signature: Date: J U L 1 1 ZU 14 Financial Services This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No❑. MM0111,011L la-m—'99-0 before approval Yes❑No❑. If budget amendment is necessary,please attach to this form. This ins ment a been pre-audited in the manner required by the Local Gove t udget and Fiscal Con Act: ! per, V c.AM Financial Services Directors Signa r stria 'Date: County Attorney Approval by Board ❑ (Contracts $90,000. 0 or more for goods or services, $250,000.00 or more for cons-ruction, or any BOCC consultant contract). Approval by ger (Most other contracts$1,000 and above). Department Director approval only❑ (Under $1,000). This contract has been revi we and approved by the Attorney as to legal form and sufficiency: A Attorney's Signature Date: L4_ County Manager This contract has been reviewed and is approved by the County Manager YesErNo❑. This contract has been reviewed and is-fir signature the Chair Yes❑No❑. Manager's Signature: Date: Clerk` o the Board Approved by BOCC on the_day of ,20 . Submitted for Chair signature on the_day of ,20 Clerk's Signature: Date: Revised March 2012