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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: Richard Simmons Drilling Party/Vendor Contact Person: Stephen Brooks Contact Phone:540-254-2289 <br /> Pa e or Address:60 Drill Rig Road City Buchanan State:VA Zip:24066 Department: Asst Management Services Amount: <br /> V6.7-0.0b Purpose:Geo-thermal test well Budget Code(s):61370035-882006-30018 Vendor# (N/A if new vendor) Vendor <br /> a BO C consultant? Yes❑No® Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 01/16/2013 <br /> p ved by Board Yes[]No® Agenda Date: Title of Contract: <br /> 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 1.664This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: t 1 t3 <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 /> 1<IT Director's Signature: Date: <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ 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: ''t4, n% A Date: t <br /> . 1tlzi« <br /> Financial Services <br /> This Contract is conditioned u n appropriation by the Board of Commissioners Yes❑Nog. A budget amendment is necessary <br /> before approval Yes❑No�f 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: A, Date: lbbIl <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�K(Most other contracts$1,000 and above). Department Director approval only❑(Under <br /> $1,000). This contract has been viewed and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: l I 6113 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yesl�T—No❑. <br /> This contract has been reviewed and is for signature by tje Chair Yes❑No <br /> Manager's Signature: <br /> lag <br /> 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 />