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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: Diane Shugars Party/Vendor Contact Person: Diane Shugars Contact *Ver Party/Vendor Address: 3310 <br /> ENVIRON WAY City CHAPEL HILL State:NC Zip:27517 Department: Health Amount isa urpose:DENTAL SERVICES <br /> AGREEMENT Budget Code(s): 10410120-630000 Vendor#56709 (N/A if new vendor) BOCC consultant? Yes❑No <br /> ® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 7/1/2013 Approved by Board Yes❑No® <br /> Agenda Date: Title of Contract:DIANE SHUGARS DENTAL 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 /> c <br /> Department Director's Signature: 4,u,— Date: <br /> IT 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 Ma a ement <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; 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: <br /> Risk Manager's Signature: % r � Date: '71;01Y <br /> `,=. ''11z.9 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[ A budget amendment is necessary <br /> before approval Yes❑NoLV.. 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 and Fiscal Contr 1 Act: <br /> Financial Services Director's Signature: G� �� "— Date: <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000.0 r 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 been reviewed"roved by the Attorney as to legal f cy: <br /> Attorney's Signature - spate: �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 t e hair Yes❑No <br /> Manager's Signature: 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 /> Clerk's Signature: Date: <br /> Revised March 2012 <br />