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►-ate <br /> ORANGE COUNTY-CONTRACT CONTROL SHEET <br /> rder: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services, (5)Attorney,(6)Manager,(7)Clerk <br /> hall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager <br /> ntract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for <br /> nust 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 Party/Vendor Contact Person: Brian Toomey Contact Phone: 919-933-8494 <br /> Party/Vendor Address:229 Lloyd Street City Carrboro State: NC Zip: 27510 Department: Public Health Amount:N/A Purpose:PHS <br /> and OCHD agree for certification of WIC clients at OCHD Budget Code(s): Vendor 9 27898 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date July 1,2013 <br /> Approved by Board Yes[]No[] Agenda Date: Title of Contract: Piedmont Health Services WIC Program <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 /> 1 <br /> Department Director's Signature: Date: " .-Q 4 <br /> IT Director <br /> (Applicable only to hardW0r 4 are urchases or related services)This contract has b �dpproved by the Information <br /> Technology Director as to technical content an mation t eci ications: <br /> IT Director's Sign; Da e. <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required 2• 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: ,�' D 7 <br /> ate: <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 Bud t /n+d Fisc?-1 Control Act- <br /> Financial Services Director's Signature: X(t yC�---w �• Date: <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,00 r more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval by Manager ] 1 Lost other contracts$1,000 and above). Department Director approval only '(Under <br /> $1,000). This contract has b revi ed and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: Z� 3 <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: Date:N ((a <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 />