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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 County Head Start and Early Head Start Party/Vendor Contact Person: Angela Wilcox Contact Phone: <br /> 919-490-5577 x247 PartyNendor Address: 800 Eastowne Drive City Chapel Hill State:NQ Zip:27514 Department: Health Amount: <br /> Purpose:Health Department Dental Program provides services to children enrolled at OCHS/EHS Budget Code(s):_ <br /> Vendor#- (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check one)New❑ Renewal <br /> [D Amendment F-1 Effective Date- Approved by Board Yes❑No❑ Agenda Date: Title of Contract:Agreement <br /> with Dental Services for Orange County Head Start and Early Head Start <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: k Date: IL20 <br /> Z <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; F-1 WC; ❑ Professional; F-1 Property; OR No Insurance Required � Hold <br /> Contract pending receipt of Certificate of Insurance Fl. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: k y Date: 2- <br /> Financial Services <br /> This Contract is conditioned appropriation by the Board of Commissioners YesE]Nov A budget amendment is necessary <br /> [_1 _2ypon ap <br /> before approval Yes❑Nol�4. 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 olAct: <br /> Financial Services Director's Signature: Date: <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 been reviewed and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's SignatuA ks" Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YesC Non. <br /> This contract has been reviewed and is for signature by th hair Yes❑NoE2-`_ <br /> Manager's Signature: Date: <br /> lerk 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 />