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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. 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: Flaircare Party/Vendor Contact Person: Anzor Gachechiladze Contact Phone: 919-960-6038 Party/Vendor <br /> Address: 1004 Mount Carmel Ch Rd City Chapel Hill State:NC Zip:27517 Department:DSS Amount: Purpose: In home <br /> service Budget Code(s)-1,v' ndor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: <br /> L <br /> (Check one)New❑ Renewal ® Amendment ❑ Effective Date Approved by Board Yes®No❑ Agenda Date: <br /> Title of Contract: <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: 6(0'3 D _16 <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 Management <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 provisions as shown, this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: 4^- Date: <br /> _WC Financial Services <br /> This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No)O. 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: Nat4w Date:-*Of 7zr-n <br /> County Attorney <br /> Approval by Board (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by a ager (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> Attorney's Signature Datel lb Zboo <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 /> Approved by BOCC on the da of ,20 Submitted for Chair signature on the day of ,20 <br /> Clerk's Signature: Date: <br /> Revised April 2010 <br />