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�ol�-alp <br /> 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: The University of North Carolina Hospitals Party/Vendor Contact Person: Nicole Driver Contact Phone: 919-966- <br /> 5581 Party/Vendor Address: 101 Manning Drive City Chapel Hill State:NC Zip: 27514 Department: DSS Amount: $49,587 Purpose: <br /> Provide Income Maintenance Worker and Sunrvisor to UNC Hospital Budget Code(s): 10403010-510000 Vendor# (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective <br /> Date 07/01/13 Approved by Board Yes[]No❑ Agenda Date: Title of Contract: <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: 6& <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 Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Require d a 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: .3 <br /> 8LZt I l3 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[o A budget amendment is necessary <br /> before approval Yes❑No[V�lf 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 Cont of Acct* ? <br /> Financial Services Director's Signature: _ f -w J d Date: 2? ,! <br /> a1:xI <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 b Manager[�(Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has been -ewe n approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature _D/� Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the Cou anager Yes O - <br /> This contract has been reviewed and is for signa r y Yes❑No <br /> Manager's Signature: Date: - �� �✓ <br /> C 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 />