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ORANGE COUNTY—CONTRACT CONTROL SHEET c')It <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: Central Carolina Tire Party/Vendor Contact Person: Thomas Womble Contact Phone: 919-499-2301 <br /> Parry/Vendor Address: 1616 McKoy Town Rd City Cameron State:North Carolina Zip:28326 Department: Solid Waste Management <br /> Amount: 80.86/ton Tires Purpose: Removal of Scrap Tires from Orange County Landfill Budget Code(s): 50351020 630003 Vendor# <br /> 43417 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract!gend one)New 11rlewal <br /> Amendment ❑ Effective Date March 1,2010 Approved by Board Yes No❑ Date: January 21,2010°Title of Contract: <br /> Agreement for Removal of Scrap Tires <br /> If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Yes No If submitted forbid <br /> were bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director <br /> as to technical content: <br /> D <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 /> T 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❑Nog]. A budget amendment is necessary <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: <br /> Financial Services Director's Signature: � �. 2 <br /> � Date: <br /> County Attorney <br /> Approval by Board)Q Contracts over $25,000.00 or any BOCC consultant contract). Approval by Manager ❑ (All contracts <br /> $25,000.00 or less with the exception of BOCC consultants). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> Attorney's Signature -- -- Date 5/f d <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 to be submitted for BOCC consideration Yes❑No❑. <br /> Manager's Signature: Date: <br /> Clerk to the Board <br /> Submitted for Chair signature: <br /> Clerk's Signature: Date' l� <br /> l 16 <br /> %.of Loe <br /> Revised December 2009 <br /> i <br />