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,z, <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 re iew should <br /> be completed through the legal review process prior to being routed for signature. <br /> Department <br /> Party/Vendor Name: Orange Grove Fire Company Party/Vendor Contact Person: Chief Steve McCauley Contact Phone: 3 6-263-2823 <br /> Party/Vendor Address:6800 Orange Grove Road City Hillsborough State:NC Zip: 27278 Department: Amount: <br /> Purpose:EMS co-location Budget Code(s): Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No <br /> ® Contract Type:(Check one)New® Renewal ❑ Amendment ❑ Effective Date September 17,2013 Approved by Board Yes <br /> ®No❑ Agenda Date: September 5,2013 Title of Contract: Use agreement for emergency medical services substation <br /> If this is a Grant Agreement,pre-application has been approved by the Boa d of Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes❑No❑ Bid/RFP ber This contract been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: t o 3 <br /> IT Director <br /> (Applicable only to hardware/softwa e 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; Vq.P operty, OR No Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With inco oration of Insuranc rovisions as shown,this contract is approved <br /> by the Risk Manager: C,e � <br /> Risk Manager's Signature: Date: ? <br /> & 9 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑NoE� A budget amendment is necessary <br /> before approval Yes❑No I 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 /> Financial Services Director's Signature: Date: l o�5 13 <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 Manager 4(Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has been r 'ewe an pproved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County ManaLer <br /> This contract has been reviewed and is a ro d by the County M nager Yes[ No❑. <br /> This contract has been reviewe is o g tur th air es❑No❑. <br /> ci <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 />