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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 /> Denartment <br /> Party/Vendor Name: The University of North Carolina at Chapel Hill Panty/Vendor Contact Person: Warren P.Newton Contact Phone: <br /> 919-966-0210 Party/Vendor Address: 590 Manning Drive City Cha e� 1 Hill State:NC Zip:27599 Department: Public Health Amount: <br /> $145,416 Purpose:Provider will render services in reference to medical director services, general consultation,and clinical services <br /> Budget Code(s): 10414020-630000 Vendor#21243 (NiA if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract <br /> Type: (Check one)New® Renewal ❑ Amendment [] Effective Date July 1,2013 Approved by Board Yes❑No❑ Agenda <br /> Date: Title of Contract: Unc Family of Medicine Service 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❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's SignaturQ:�`� �W CA413 Date: 61--5-1-3 <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 techljology specifications: <br /> IT Director's Signature: Date: <br /> t/ A4k Ma[ ement <br /> Include the following coverages: CGL; [�utWC; Professional; ❑ Property; OR No Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance [ With it,curporadon of insurance provisi ns as shown,this ontract is approved <br /> by the Risk Manager: � �� � <br /> Risk Manager's Signature: Date: <br /> Financial Services <br /> This Contract is conditionev <br /> on appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary <br /> before approval Yes❑No 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 Control Act: <br /> aa,4,u�, ��Financial Services Director's Signature: ,ol• ��/��. Date: <br /> -I 130 <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 anager%(Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has been ev we roved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature __________________ Date:10 9 L3 <br /> Cyt!nty,iltsi.�a ��r <br /> This contract has been reviewed and is ppr ed the County iV1ai�,,gci Yes[[]No❑. <br /> This contract has been reviewed an for si ur by -ha' es❑`�o❑. <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 />