Orange County NC Website
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: Adolescents in Need Party/Vendor Contact Person: Betty Compton Contact Phone: 919-843-8263 Party/Vendor <br /> Address: UNC Medical School City Chapel Hill State:NC Zip: 27515 Department: Outside Agency Amount: $32,194 Purpose: <br /> Budget Code(s): 10495050 710010 Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract <br /> Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1,2010 Approved by Board Yes®No❑ Agenda <br /> Date: June 15,2010 Title of Contract: 2010-11 Outside Agency Performance Agreement <br /> If this is a Grant Agreement,pre-application has been approved y t Board of Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes[]No❑ Bid/RFP numb e ont act has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: 0 <br /> P g <br /> IT . ector <br /> (Applicable only to hardware/sof4vare 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 El. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: Date: <br /> Financial Services <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary <br /> before approval Yes❑ NoZ If budget amendment is necessary,please attach to this form. h s 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: �'�+�`' , � Date: � 3' � � <br /> A <br /> County Attorney <br /> Approval by Board X(Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Manag r (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> Attorney's Signature Date: 1 3( 1 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Ye's❑No❑. <br /> This contract has been reviewed and is to be submitted for BOCC consideration Yes No <br /> Manager's Signature: Date: — ( r <br /> Clerk to the Board 9 <br /> Approved by BOCC on the L-'�day of 8ubmitted for Chair signature on the day of /60 <br /> Xx -- <br /> Clerk's Signature: Date: 9 <br /> Revised April 2010 <br />