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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: UNC Family Medicine Party/Vendor Contact Person: Ron Linsley Contact Phone:919-966-1200 Party/Vendor <br /> Address: 590 Manning Drive City Chgpel Hill State:NC Zip:27514 Department: Health Amount: 145,416 Purpose: Medical <br /> Director/Physician Services for Health Department Budget Code(s): 10414020 630000 Vendor#21243 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑NoE Contract Type: (Check one)New El Renewal Z Amendment F-1 Effective Date July 1,2012 <br /> Approved by Board Yes❑No❑ 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❑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: DateV I q 1) <br /> IT Director <br /> (Applicable only to hardvvarelsojtware purchases or related services)This contract has been reviewed and approved by the Information <br /> Technology Director as to technical cor"-mt and information technology specifications: <br /> IT Director's Signature: ------ Date: <br /> Risk Ma!3agement <br /> Include the following coverages: ❑ CGL; ❑ Aul'o; Q WC; 9 Professional; [:1 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: 241 12- <br /> � <br /> Financial Services <br /> This Contract is conditioned hon appropriation by the Board of Commissioners YesE]Nol/ A budget amendment is necessary <br /> before approval Yes❑No[g. 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 Con I Act* <br /> Financial Services Director's Signature: (Y"Clu_ o PJt-,� Date: V ul ��"' <br /> Countv Attorney <br /> Approval by Board ❑ (Conti-acts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval Department nap-Cr&(most other contracts$1,000 and above). Depament Director approval only F1 (Under <br /> ,t has b <br /> $1,004 This contract I ewe, an a roved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: 101 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Yanager Ye NoLl.— <br /> This contract has been reviewed and is for signature by esFINov <br /> Manager's Signature: 190 Date: 2 <br /> It V UIL <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 />