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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: Orange Public Transportation Party/Vendor Contact Person: Al Terry Contact Phone: 919-245-2002 <br /> Party/Vendor Address:600 Public Works Dr City Hillsborough State:NC Zip:27278 Department: DSS Amou 12.75 per way <br /> client Purpose:Medicaid Transportation Budget Code(s): Vendor# (N/A if new vendor) Vend1 <br /> consultant? Yes❑No❑ Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 7/1/2013 Approved by <br /> Board Yes❑Nor-1 Agenda Date: Title of Contract:Medicaid Transportation Memorandum of Understanding <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 /> T Director <br /> (Applicable only to hardware/software 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 M/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: 7 <br /> Financial Services <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑NoW A budget amendment is necessary <br /> before approval Yes❑No.IIf 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_Fisccal Control ct: g <br /> Financial Services Director's Signature: Date: <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 anager E] (Most other contracts$1,000 and above). Department Director approval only (Under <br /> $1,000). This contract has en evM' ed and approved by the Attorney as to legal form and suffic'ency: . 1 <br /> Attorney's Signature Date: <br /> County Manage j°� <br /> This contract has been reviewed and is approved by the County Manager Yee <br /> This contract has been reviewed and is for signature b t C air Yes❑No <br /> Manager's Signature: Date: <br /> Clerk to the Board <br /> Approved by BOCC on the_day of Submitted for Chair signature on the day of 20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />