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e_�Azl <br /> 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: Appalachian District Health Department Party/Vendor Contact Person: Angela R. Scott Contact Phone: 336-372- <br /> 8813 Party/Vendor Address:PO Box 309 City Sparta State:NC Zip:28675-0309 Department:Health Amount: 800 Purpose: <br /> Consulting Budget Code(s): 10414020-630000 Vendor#61789 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® <br /> Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 1/1/2013 Approved by Board Yes❑Non <br /> Agenda Date: Title of Contract:PATAGONIA CONSULTANT <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❑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 /> 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 Required (r 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: /� t <br /> Risk Manager's Signature: y(/ U/,Vn- Date: f <br /> Financial Services <br /> This Contract is conditioned u n appropriation by the Board of Commissioners Yes❑No[ 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 ContA ol Act:/� p <br /> Financial Services Director's Signature: �L Date: T/d � 13 <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 ay 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 revie d d approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes[]No❑. <br /> This contract has been reviewed and is for signature by the Chair Yes❑No❑. <br /> Manager's Signature: 1L 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 />