R 2010-063 Co Manager - EmPOWERment outside agency agreement

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� -3 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 approval. 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: EmPOWERment Party/Vendor Contact Person: Delores Bailey Contact Phone: 919-967-8779 Party/Vendor Address: 109 N. Graham St. City Chapel Hill State:NC Zip: 27516 Department: Outside Agency Amount: $13,000 Purpose: Budget Code(s): 10495050 789005 Vendor#800065 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1,2010 Approved by Board Yes®No❑ Agenda Date: June 15,2010 Title of Contract: 2010-11 Outside Agency Performance Agreement 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 h' act has been reviewed and approved by the Department Director as to technical content: Department Director's Signature: Date: '' `-- P g IT irec or (Applicable only to harrdware/sof4vare purchases or related services)This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Management Include the following coverages: E?CfGL; EJ—Auto; L;]-�C; ,Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved by the Risk Manager: Risk Manager's Signature: Date: <� l� Financial Services This Contract is condition d pon appropriation by the Board of Commissioners Yes❑Noy A budget amendment is necessary before approval Yes❑No If budget amendment is necessary, please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Bud he_t,and Fiscal Control Act: G Financial Services Director's Signature: Date: County Attorney Approval by BoarContracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant contract). Approval by Manager ❑ (All other contracts). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorney's Signature / Date: County Manager This contract has been reviewed and is approved by the County Manager Yes No❑. This contract has been reviewed and is to be submitted for BOCC consideration YesDTI701_1. Manager's Signature: Date: �J Cleric to the Board Approved by BOCC on the day of ,20 Submitted for Chair signature on the ay of ,20 Cleric's Signature: lyi ouk Date: (i Revised April 2010