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ZOI Z-4(p) <br /> 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 /> PartyNendor Name: Robert E.Dupuis PartyNendor Contact Person: Robert E. Dupuis Contact Phone: PartyNendor Address: <br /> 205 Kenilworth Place City Chapel Hill State:NC Zip:27516 Department:Health Amount: $ Purpose:Provide Pharmacy Services <br /> Budget Code(s): 10414020 630000 Vendor#47361 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No Contract <br /> Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date July 1,2012 Approved by Board Yes❑No Agenda <br /> Date: Title of Contract: <br /> If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners YesE Non. 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: Lint ,;i-k- •r.^"' <br /> Department Director's Signature: Date: 6/Q01 la <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; 0 WC; g Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance p. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: r,Risk Manager's Signature: �• il , Date: (l` <br /> lee c d o G/2 i/ice -1%Y►.a-?o <br /> Financial Services <br /> This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary <br /> before approval Yes❑No If budget amendment is necessary,please attach to this form. his instrument has been pre-audited in the <br /> manner required by the Local Government Budget and Fiscal Cont of Act: t/ <br /> Financial Services Director's Signature: � G+-t�.� Date: GI Z` ( 2 <br /> —Pa::.. (.1 Z°I <br /> County Attorney <br /> Approval by Board ❑ (Contract over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Mana_• 1J (All •ther contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> Attorney's Signature Milt -.12./ Date: es-- <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes S N❑. <br /> This contract has been reviewed and is to be ubmitt-+ for BO C consideration Yes❑NoEj <br /> A <br /> Manager's Signature: _ ) )/ / Date: 7— /0 - /Z.- <br /> erk 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 April'2010 <br />