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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: State of North Carolina Party/Vendor Contact Person: State Health Director Contact Phone: 919-707-5000 <br /> Party/Vendor Address:5605 Six Forks Road City Ralei h State:NC Zip:27609 Department:Public Health Amount:NIA Purpose: <br /> Maintaining and promoting_the advancement of public health in North Carolina Budget Code(s):N/A Vendor#NA (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective <br /> Date July 1,2013 Approved by Board Yes❑Non Agenda Date: Title of Contract:North Carolina Department of Health <br /> and Human Services Consolidated Agreement <br /> If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes®Na❑. If submitted for bid were <br /> bidstRFPs received Yes❑Non BidtRFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: ,� 1 <br /> " IT irector <br /> (Applicable only to hardware/software p o a laced servic is contract has been reviewed and approved by the Information <br /> Technology Director as to technical content and informa 1mc2lo`specifications: <br /> IT Director's Signature: `~. Date: <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required V. 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. f�� <br /> Risk Manager's Signature: l,( � � J� Date: �r r u <br /> Financial Services <br /> This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑Nog./ A budget amendment is necessary <br /> before approval Yes❑NoY. 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 Buddgfeet and Fiscal Control Act: <br /> Financial Services Director's Signature: U( t f.-� A AV, Date: 2d-I, <br /> County Attorney <br /> Approval by Board M(Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or apy 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 be v'ewe roved by the Attorney as to legal form and suffi ' c : <br /> KUC ccppmrct{ or7u I j st5n $ 231z_tt>1 l <br /> Attorney's Signature Date. 3 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Managerr,X�eg-, No❑. <br /> This contract has been reviewed and ' g y hair Yel ob �y <br /> Manager's Signature: ate: <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 />