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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: University of North Carolina Hospitals Party/Vendor Contact Person: Jancie Summers Contact Phone: 919-966- <br /> 5 Aa /Ve dor Address: 101 Manning Dr City Chapel Hill State:NC Zip:275]4 Department: DSS Amount: not to exceed <br /> 49 58 ose:provide a full time Income Maintenance Caseworker Budget Code(s): Vendor# (N/A if new vendor) <br /> V r is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date <br /> 07/01/12 Approved by Board Yes®NOD Agenda Date: Title of Contract:Agreement Between The University of North <br /> Carolina Hospitals and Orange County,North Carolina <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: G- Date: <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; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ['l 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: ZA IL <br /> `Iht 111-1 <br /> 4kz Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[ A budget amendment is necessary <br /> before approval Yes❑ No[A.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: l�l /J• AU, Date: 7 Zfi <br /> Count Attorne <br /> Approval by Board ❑ (Contracts $90,000.0 ore for goods or services, 000.00 or more for construction, or any BOCC <br /> consultant contract). Approval b ger (Most other cod tracts$1,000 and above). epartment Director approval only❑ (Under <br /> $1,000). This contra r wed and approved by the Attorney as to legal form and s fficienc <br /> Attorney's Signature e: 27 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes <br /> This contract has been reviewed and is for signature the hair Yes❑No�- <br /> Manager's Signature: Date: 7 /v� 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 March 2012 <br />