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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 /> Party/Vendor Name: Orange Public Transportation- Party/Vendor Contact Person: At Terry Contact Phone:919-245-2002 <br /> Party/Vendor Address: 600 Public Works Dr City Hillsborough State:NC Zip: 27278 Department:DSS Amount: $12.75 per way per <br /> client Purpose: Medicaid Transportation Budget Code(s): Vendor# (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes❑No❑ Contract Type: (Check one)NewEj Renewal E Amendment ❑ Effective Date 07/01/12 Approved by <br /> Board Yes❑No❑ Agenda Date:06/15/12 Title of Contract:Mediciad Transportation Memorandum of Understanding <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: <br /> Department Director's Signature: Date: <br /> *� rccor <br /> (Applicable only to hardware/software ppurchas s 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; ❑ WC; El Professional; ❑ Property; OR No Insurance Required & 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: Date: <br /> Financial Services <br /> This Contract is conditioned j4pon appropriation by the Board of Commissioners Yes❑NoEd A budget amendment is necessary <br /> before approval YesE]Nou�. 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 and Fiscal Control Act: <br /> Financial Services Director's Signature: h•- /vx, Date: <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000.00 gy more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval Manager (Most other contracts$1,000 and above). Department Director approval only El (Under <br /> K <br /> $1,000). This contrac t has be vie d approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YeRffNo❑. <br /> This contract has been reviewed and is for signature y the Chai Yes❑No2.- <br /> Manager's Signature: Date;!. ,- <br /> Clerk to the Board <br /> Approved by BOCC on the—day of 0 Submitted for Chair signature on the day of 20_. <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />