R 2010-071 Co Manager - Rape Crisis Center outside agency agreement

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U � I 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: Rape Crisis Center Party/Vendor Contact Person: s Contact Phone: 9 -4647 Party/Vendor Address: PO Box 4722 City Chapel Hill State:NC Zip: Department: Outside Agency Amount: 25,000 Purpose: Budget Code(s): 10495050 710009 Vendor#800015 (N/A if new vendor) Vendor is a BOCC consulta es ❑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 This c act has been reviewed and approved by the Department Director as to technical content: C Department Director's Signature: ��f`� Date: ;l I i ctor (Applicable only to hardware/software purchases or related services his c ct 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: [. Y CGL; ❑Auto; R WC; 0 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: �QiYyt Date: 8 !o gee "a Vt�ho Financial Services This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑Noy. A budget amendment is necessary before approval Yes❑ NoMf. If budget amendment is necessary, please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Financial Services Director's Signature: 644,t-4, Date: County Attorney Approval by Board X (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant contract). Approval by Ma ger*(All other contracts). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorney's Signature Date: 12S Lol p County Manager This contract has been reviewed and is approved by the County Manager Ye D No❑. This contract has been reviewed and is to be submitted for BOCC consideration Y No❑. Manager's Signature: Date: 2' v lerlc to the Board 1()Approved by BOCC on the day of 20 Submitted for Chair signature on the ay of ,20/0 .Clerk's Signature: Date: 911 Revised April 2010