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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: Unc School of Dentistry Party/Vendor Contact Person: Martha B.Barbour Contact Phone: 919-537-3570 <br /> Party/Vendor Address:467 Brauer Hall City Chapel Hill State:NC Zip: 27599 Department:Public Health Amount:$55,848 Purpose: <br /> Provider will provide one or more postgraduate year one or two level in the Dental Health Services Divsions to provide ambulatory dental <br /> services for the academic year 2013-2014 Budget Code(s): 10410420-630000 Vendor#36302 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes❑No® Contract Type: (Check one)New®Renewal ❑ Amendment ❑ Effective Date July 1,2013 <br /> Approved by Board YesD No❑ Agenda Date: Title of Contract: Graduate Resident Services <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 Signatu C.Mb Date: Q— -13 <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 /> ��-+e►^s R k Mana mentL � <br /> Include the following coverages: [Vf -CGL; [V Auto; C; Professional; ❑ Property; OR No Insurance Required R. Hold <br /> Contract pending receipt of Certificate of Insurance anc� With incorporation of Insurance provisions as shown, this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: Date: Z <br /> Z4-c-- , `°'I h <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❑No[HIf 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: .'t u _� /)4 --- Date: V v J.3 <br /> lalza <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 Manager other contracts$1,000 and above). Department Director approval only E] (Under <br /> $1,000). This contract has be +ew d approved by the Attorney as to legal form and sufficient : <br /> 1! , <br /> Attorney's Signature Date: I 3 IS <br /> County Manager <br /> This contract has been reviewed and is r v y the ounty Manager Yes❑No❑. <br /> This contract has been reviewed s fo i a re e it s❑No❑. <br /> v <br /> Manager's Signature: Date: 111112�,/ZV <br /> Clerk to the Board <br /> Approved by BOCC on the_day of 120 Submitted for Chair signature on the_day of ,20 <br /> Clerk's Signature: Date: <br /> Revi.sed March 2012 <br />