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"Zd!A- y(It) <br /> ORANGE COUNTY—CONTRACT CON17R0D. 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 oumplete,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: Wake Radiology Party/Vendor Contact Person: Michele Jackson Contact Phone: 919-788-7904 9amyNcndnr <br /> Address:3949 Browning Place City Raleigh State: nc Zip: 27609 Department: Health Amount:per view charge Purpose: Chest X- <br /> Ray Budget Code(s): 10414020 631000 Vendor#2769/ (N/A if new vendor) Vendor is a BOCC consultant? Yes 0 No <br /> Contract Type: (Check one)New Fl Renewal Amendment 0 Effective Date 7/1/2012 Approved by Board Yes[]No <br /> Agenda Date: Title of Contract: <br /> If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yco0Y«o0. If submitted for bid were <br /> hido/QFPo received Ycx0No0 Bid/BFPoumhe, This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: 4.-- Date: 2,5-'-(2 <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 Mana ement <br /> Include the following coverages: 0 COL; 0 Auto; Ej WC; Professional; 0 Property; OR No Insurance Required O. Hold <br /> Contract pending receipt of Certificate of Insurance E. With incorporation of Insurance provisions as shown, this contract is approved <br /> by the Risk Manager: <br /> � � z.�•/�~� <br /> ��ixkManager's guutorm:~�/0/��l Date: � ",~ � <br /> uy. �� //� /^� �� ' ' <br /> ��� ~ �v ~ =y�c��� �����1-_�� <br /> Financial Services <br /> This Contract is condition appropriation i by the Board f C i i YvsFN A budget amendment is necessary <br /> before p po va iYua0 �v lfhuotamendment is necessary, please m1uobtnthis form. T s inx�umcnthas been pre-audited in the <br /> ya tild f�manner required by the Local overtunent Budget and Fiscal Control Act: <br /> FiououiuY8crviuew]�imcu0or`y8igoutpre: , ~����� Date: � - <br /> _1 1~=_-.Lp ^1 <br /> a=1 <br /> County Attorney <br /> Approval by Board �� (Contracts $90'008.00 or more for goods or services, $250,000.00 or more for conx�ucioo, or any BOCC <br /> ^� <br /> consultant contract). &ppnov by uoa� (Most tb cruo m�ac to$1,000 and above). DepunmcutDirector approval only 0 <br /> (Under <br /> �$l.O0O). This oon�ucthas du dn proved hy the&uocuuyaxto legal form uudxuf5c ouy: <br /> lit . <br /> �Attoroxy,s8iguutmre -� �-1". Date: -7 K / - <br /> i-ot2_ <br /> " <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager `/osp7lHo0. <br /> This contract has been reviewed and is for signature by the Cha. l/esFlNn[a.' <br /> Manager's Signature: DAL / <br /> Datc:7 <br /> —/6.-/ Z.- <br /> Clerk to the Board <br /> /\ppnovcdbyB0CCondhedayof .20 . Submitted for Chair signature on the day of ,20 . <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />