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�os�- 108 <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: Piedmont Health Services,Inc., Party/Vendor Contact Person: Marni Holder Contact Phone: 933 8494 <br /> Party/Vendor Address:299 Lloyd Street City Carrboro State:NC Zip:27510 Department: HEALTH Amount: 000 se: The <br /> fundin will be used to su ort the Piedmont Health Services Inc.communi health center mission of rovid' me yj di gent <br /> residents of Orange Coup with access to a comprehensive,sliding-fee primgU care home including medical 6nd den are(ancillary <br /> health support services are also provided but are not supported by this grant) Budget Code(s): 10414020-6300 endor#27898 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal❑ Amendment ❑ <br /> Effective Date JULY 1,2012 Approved by Board Yes❑No❑ Agenda Date: Title of Contract:OUTSIDE AGENCY <br /> PERFORMANCE AGREEMENT:PIEDMONT HEALTH SERVICES <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❑No❑ 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 tar tware purchases or related services ntract has been reviewed and approved by the Information <br /> 7 Technology Director as to technical co d inform at' ology specifications: <br /> IT Director's Signature: Date: <br /> eisk;Man�emesnt <br /> Include the following coverages: WCGL; [Auto; C fesional; ❑ 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: �' �• Date: Z� <br /> Financial Services <br /> This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[ l A budget amendment is necessary <br /> before approval Yes❑No 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 nd Fiscal Control Act: /` <br /> Financial Services Director's Signature: Date: `1 2S (3 <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). Approv by Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has b e evi d approved by the Attorney as to legal form and suffic' ncy: <br /> Attorney's Signature Date: 4 so L? <br /> County Manager <br /> This contract has been reviewed and is approved by the Co ty Manager Y� <br /> This contract has been reviewed and is for si a C ' Yes❑N <br /> Manager's Signature: <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 /> Revised March 2012 <br />