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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 /> 10 41 L4 0 e_*0 Co3 03--.10 <br /> Department <br /> Party/Vendor Name: UNC Dept of Family Medicine School of Medicine Party/Vendor Contact erson: Warren P.Newton,MD <br /> Contact Phone: Party/Vendor�Address: 590 Manning Drive City Chapel Hill State:NQ ip: 27599 Department:UNC Dept of <br /> Family Medicine Amount-;/,f2.000 'J, Fpose:Tabasco Treatment Specialist Budget Code(s): Vendor#21243 (N/A if new <br /> vendor) Vendor is a BObC—cods'ultant? Yes❑Noo Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective <br /> Date February 1,2013 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❑Non. If submitted for bid were <br /> bids/RFPs received Yes❑Non 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: <br /> IT Director <br /> (Applicable only to hardwarelsoftware 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 Require � 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: d4a,_,4, Date: <br /> Financial Services <br /> This Contract is conditioned lipon appropriation by the Board of Commissioners Yes❑No[g� A budget amendment is necessary <br /> before approval YesEl Nog. 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 Control Act: <br /> Financial Services Director's Signature:_U41141� /J. A,- Date: <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000,,09 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approv yMan Ver�a�(M�ost other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has*evie d d approved by the Attorney as to legal form and sufficiqncy- <br /> Attorney's Signature- Date: 351 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Ye$Eallon. <br /> This contract has been reviewed and is for signature by the Chair YesF]No[D'— <br /> Manager's Signature: 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 />