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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: Chapel Hill Carboro City Schools Party/Vendor Contact Person: Tom Forcella Contact Phone: 919-967-8211 <br /> ext28 /Vendor Address: 750 S.Merrit Mill Road City Chapel Hill State:NC Zip: 27516 Department: Public Health Amount: <br /> $ 1 651 ose: Providing school nursing services to the students in the Chapel Hill Carrboro city school system Budget Code(s): <br /> 1041 40211--630000 Vendor#616309 (N/A if new vendor) Vendor is a BOCC consultant? Xj ®No❑ Contract Type: (Check one) <br /> ew ® Renewal Amendment ❑ Effective Date July 1,2013 Approved by Board YesN No❑ Agenda Date: <br /> Title of Contract:Nursing Services between OCHD and Chapel Hill Carrborro City Schools <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: - I <br /> ( pp o hardware/software purchases or related services)This contract has been reviewed and approved by the Information <br /> Technology Director as to tec nica co olo y specifications: <br /> IT Director s I <br /> Risk Management <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required Hold <br /> Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: j �• Vr'"' Date: <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[V. A budget amendment is necessary <br /> before approval Yes❑ Novlf 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 Control Act: <br /> Financial Services Director's Signature: XAL, 4� At Date: <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 Ma ger❑ (Most other contracts $I,GOO and above). Department Director approval"only ❑ (URder <br /> This c ntract has been revie and aplr proved yth Atto ne as f nd sufficiency: � r��{ <br /> Attorney's Signature Date: <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 sign y t Les Manager's Signature: Date:d Approved by BOCC on the day of 20 . or Chair signature on the_day of 20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />