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aoi3^ ab� <br /> ORANGE COUN T. -CONTRACT CONTROL SHEET <br /> Routing Order: (1) Department,(2)IT,(3) Risl< Nlaliauement. (4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk <br /> This Document shall accompany all contracts and shay 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 Party/Vendor Contact Person: Brian Toomey Contact Phone: 781-687-9500 <br /> Party/Vendor Address: 229 Lloyd Street City Carrboro State:NC Zip: 27510 Department: Public Health Amount:N/A Purpose: <br /> Services to be rendered by the County to PHS with respect to: Twenty hours per week services of a NC licensed registered dietitian <br /> Budget Code(s): 10414020-630000 `Vr ).DS'CjE if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: <br /> (Check one)New ® Renewal ❑ Amendment U Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date: <br /> Title of Contract: Registered Dietitian Services Agreement <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: __ 71irlctor Date:If <br /> (Applicable only to hardware/software purchases or relaied s-;rvices)This contract has been reviewed and approved by the Information <br /> Technology Director as to technical content and information technoiogy specifications: <br /> IT Director's Signature: Date: <br /> Risk Manazement <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required VHold <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: � w Il-3 <br /> g <br /> Financial Services <br /> This Contract is conditioneVuon appropriation by the Board of Commissioners Yes❑No[� A budget amendment is necessary <br /> before approval Yes❑No budget amendment is necssan, please attach to this form. This instrument has been pre-audited in the <br /> manner required by the Local Government Budget and Fiscal Control (t! ?? <br /> Financial Services Director's Signature: C/ A—" Date: l �J <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000. 0 or more for goods or services, $250,000.00 or more for construction, or any 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 en evi ed and approved by the Attorney as to legal form and suffic'ency, <br /> Attorney's Signature Date: '2,37,6 <br /> County Manager <br /> This contract has been reviewed and is approved by the Coun anager Ye o <br /> This contract has been reviewed and is for s' r th Cr , Yes❑No <br /> i <br /> Manager's Signature: <br /> Date: <br /> erk to the Board <br /> Approved by BOCC on the_day of f'^,2i1 Snbrnitted for Chair signature on the_day of ,20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />