Orange County NC Website
1L- ic-t, S` d <br /> ORANGE COUNTY-CONTRACT CONTROL SHEET <br /> Q �.r <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 /> PartyNendor Name: Dr. Theodore Oldenburg PartyNendor Contact Person: Dr. Theodore Oldenburg Contact Phone: <br /> PartyNendor Address:734 Cedar Club Circle City Chapel Hill State:NC Zip:27517 Department: Health Amount: $700/clinic-not to <br /> exceed$35,000 for the year Purpose: Provide Dental Services to Clients Budget Code(s): 10410120 630000 Vendor#37639 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes❑No11 Contract Type: (Check one)New ❑ Renewal // Amendment ❑ <br /> Effective Date July 1,2012 Approved by Board Yes❑No❑ Agenda Date: 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: ��/�,� �- Q <br /> Department Director's Signature: �ifiG�-�— . � Date: e�l <br /> /10- <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 1VI agement <br /> Include the following coverages: ❑ CGL; ❑ Auto;JD <br /> WC; 91 Professional; ❑ Property; OR No Insurance Required O. 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: Cea '-A_- .1 Date: fit 911 2- <br /> Financial Services <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑Nok'. A budget amendment is necessary <br /> before approval Yes❑ NoK. 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 nd Fiscal Control Act: <br /> Financial Services Director's Signature: ter , ,,..--- Date: ?/VI-- <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000 00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval e Manager[(Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has be iewe�i dLpproved by the Attorney as to legal form and suffici cy: <br /> Attorney's Signature '4, �, Date: a. <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes o❑. <br /> This contract has been reviewed and is for sit re b, the . air Yes❑No2' <br /> 6j I 0 AM Date: 7 �v ' � <br /> Manager's Signature: _ <br /> Clerk to the Board, <br /> Approved by BOCC on the^day of ,20 . Submitted for Chair signature on the day of_ ,20 <br /> Clerk's Signature: _ Date: <br /> Revised March 2012 <br /> IIIIIIIMIIIIIIIIMMMMIIMIMMIIIMMIIIMMI <br />