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ORANGE COUNTY—CONTRACT CONTROL SKEET <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 /> Party/Vendor Name: Carol Foster Party/Vendor Contact Person: Carol Poster Contact Phone: Party/Vendor Address:P. O. Box <br /> 284 City Yanceyville State: NC Zip:27379 Department:Health Amount:$ 14,500 Purpose: Screener/Educator for Smart Smiles <br /> Dental Screening,Education and Referral Program for Young Children Budget Code(s): 10410020 630000 Vendor#615987 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal El Amendment ❑ <br /> Effective Date July 1,2012 Approved by Board Yes❑NoO 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❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: '70010\1 <br /> ff Direcotor <br /> <� pi«abi�Qn�y ro saJ9ware purchases ar rdared 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: IdCGL; M Auto; &f WC; 9 Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance Y. With incorporation of Insurance provisions as shown, this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: <br /> �{rv`�-mot✓ /✓ J '>, Date: b i f't2 <br /> Financial Services <br /> This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑NoQ� A budget amendment is necessary <br /> before approval Yes <br /> 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 Goveniment Budget and Fiscal Control Ac/pt, <br /> Financial Services Director's Signature: /)' /d4v- pi Date:_ fit 112- <br /> County Attorney <br /> Approval by Board ❑ (Contracts ov r $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Manage (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Ye43'fio[]. <br /> This contract has been reviewed and is to be submitted for BOCC consideration Yes❑NoQ-' <br /> Manager's Signature: _Date: �r <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 />