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) <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: Duke HomeCare&Hospice PartyNendor Contact Person: Dale Horton Contact Phone: 919-668-0727 <br /> PartyNendor Address:4321 Medical Park Drive, Suite 101 City Durham State:NC Zip:27704 Department: Outside Agencies <br /> Amount: $1,000 Purpose: Outside Agency Budget Code(s): 10495050-710026 Vendor#50707 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes 0 No i4 Contract Type: (Check one)New 0 Renewal P Amendment Ej Effective Date 07/01/2012 <br /> Approved by Board Yes EI No0 Agenda Date: 06/19/2012 Title of Contract: 2012-13 Outside Agency Performance Agreement <br /> If this is a Grant Agreement, pre-application has bee i approved by the Board of Commissioners Yesn NoE]. If submitted for bid were <br /> bids/RFPs received YesE]NoE] Bid/RF'Inu 1,I e This contract has been reviewed and approved by the Department Director as to <br /> technical content: 1 <br /> ■ , . <br />' 1.III <br /> • ‘ <br /> Department Director's Si. , . ure: ..2 Date: 7_ i _i 1-- <br /> ...11 <br /> IT 0 rector <br /> (Applicable only to harchvare/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; EirAuto; WC; Professional; Property; P OR No Insurance Required [1. Hold <br /> Lr <br /> 0 0 <br /> Contract pending receipt of Certificate of Insurance i With incorporation of Insurance provisions as shown, this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: ake....._ • Date: 11 1-41 II' <br /> • <br /> Financial Services <br /> This Contract is conditioneon appropriation by the Board of Commissioners YesEINo . A budget amendment is necessary <br /> before approval Yes[1 No[ . 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 Bu t and Fiscal Co trol A t: <br /> Financial Services Director's Signature: • Date: -7i7A,(if 2,- <br /> County Attorney <br /> Approval by Board Z (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Maria: LI (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> iI <br /> f VII) I <br /> 1 112-- <br /> Attorney's Signature 66 16 Aalkk Date: 2.1 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yestlislop. <br /> This contract has been reviewed and is to be submitted for BOCC consideration YesEqoEl. <br /> Manager's Signature: AI <br /> II / / alP Date: --7 --(-2-- <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 April 2010 <br />