R 2013-060 Health - Amanda Holliday for Medical Nutrition Therapy $3,000

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ORANGE COUNTY—CONTRACT CONTROL SHEET . Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk r: This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: Amanda Holliday Party/Vendor Contact Person: Amanda Holliday Contact P Party/Vendor Address: 412 Brandywine Rd. City Chapel Hill State:NC Zip:27514 Department:Health Amount:$3 0 Pu se:Medical Nutrition Therapy Documentation Budget Code(s): 10-414020-630000 Vendor#61743 (N/A if new vendor) en a BOCC consultant? Yes❑No ® Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective Date III Approved by Board YesQ No® Agenda Date: Title of Contract: If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes No If submitted forbid were bids/RFPs received YesQ No0 Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: Department Director's Signature: r Date: IT Director (Applicable only to hardwarefsoftware purchases or related services)This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Management Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; ❑ OR No Insurance Required [ Hold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved by the Risk Manager: Risk g er Mana g 's Signature: � '�`' / ✓d �'�'' Date: -13 Financial Services This Contract is conditioned Vpon appropriation by the Board of Commissioners Yes❑No V❑/. A budget amendment is necessary before approval Yes❑ Nog.. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Contro Act: Financial Services Director's Signature: 0j a^t^� Date; County Attorney Approval by Board ❑ (Contracts over $25,000.00 or any BOCC consultant contract). Approval by Manager , (All contracts $25,000.00 or less with the excep^n of B CC consultants). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorney's Signature Date: I3 County Manager This contract has been reviewed and is approved by the County Manager YesT NoM. This contract has been reviewed and is to be submitte r BO onsideration Yes❑N.Q Manager's Signature: Date: `� f( j CI to the Board Submitted for Chair signature: Clerk's Signature: Date: Revised December 2009