Orange County NC Website
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 Hospitals Party/Vendor Contact Person: Susan Blalock Contact Phone: 919-966-3887 Party/Vendor <br /> Address: 101 Manning Drive City Chapel Hill State:NC Zip:27514 Department:Aging-Wellness Amount: $25,000 Purpose:partial <br /> funding for Senior Public Health Educator position Budget Code(s):29430305-499999 Vendor#30892 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date <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❑Nor-1. 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: 10-11-12— <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 S, 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: � I Risk Manager's Signature: " ✓L J?"— Date: ( v 411 Z <br /> . Lot 16 e <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑NoE/ A budget amendment is necessary <br /> before approval Yes❑No[TIf budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the <br /> manner required by the Local Government Budg�et and- �Fiscal Control Act: <br /> Financial Services Director's Signature: `j f a�A A , AV, Date: t of l 4 1 Z- <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000 00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval by Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has b e (r viewed d pproved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: l c7 18 t i. <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes[,io❑. <br /> This contract has been reviewed and is for signat�xF by theChair Yes❑No <br /> Manager's Signature: li` Date: <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 />