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131 �5� 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: Robert E. Dupuis Party/Vendor Contact Person: Robert E. Dupuis Contact Phone: 919-966-6 artyNendor <br /> Address: 205 Kenilworth Place City Chapel Hill State:NC. Zip: 27516 Department: Public Health Amount: $-1�L,397 ,urpose: Direct <br /> Pharmacy Services at the two pharmacy sites of the Health D=partxrnen1 Budget Code(s): 10414020-63000 'Vend - "N/A (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal mendment ❑ Effective <br /> Date July 1,2013 Approved by Board Yes[]No❑ Agenda Date: Title of Contract: Pharmacy Services 2013-2014 <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 /> s <br /> Department Director's Signature: Date: <br /> (App is re/so tware purchases or related services)This contract has been reviewed and approved by the Information <br /> Technology Director as to technical content and information tec no ogy spec> >ca tons. <br /> � ec ors _ Date: <br /> Risk Ma a ement <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; M Professional; ❑ 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: n� <br /> l.0 � L <br /> Risk Manager's Signature: • Date: pill <br /> Financial Services <br /> This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑No[/y�. A budget amendment is necessary <br /> before approval Yes❑NoE9 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 Bud et and Fiscal Cont r I Act: <br /> Financial Services Director's Signature: C ��"'^�'� )L Date: �G <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). Approval by Manager X(Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has been a iew d approved by the Attorney as to legal form and sufficie cy: <br /> Attorney's Signature Date: �6 0 <br /> County Manager <br /> This contract has been reviewed and is approved by the Cou ty Manager Y <br /> This contract has been reviewed and is for ture y Elerk es❑No <br /> Manager's Signature: Date: <br /> 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 />