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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: Patterson Dental Party/Vendor Contact Person: Jim Hove Contact Phone: 919.614.5818 Party/Vendor Address: <br /> 6520 Meridian Dr# 132 City Raleigh State:NC Zip: 27616 Department: Public Health Amount: $1,400 Purpose: Provider will <br /> procure and deliver the products and services as it relates to TRG-Consecutive Training Budget Code(s): 61370035-800100-30012 <br /> Vendor#24726 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal <br /> ❑ Amendment ❑ Effective Date October 1,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: <br /> TRG-Consecutive Training <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: -1 <br /> ( pp l to hardware/software purchases or related services)This contract has been reviewed and approved by the Information <br /> Technology Director as ntent and information technology specifications: <br /> irec or s igna Date: <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 ❑. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: L°-a, , ,ate� <br /> Risk Manager's Signature:_�a (� Date: <br /> Financial Services <br /> This Contract is conditioned en 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 /> Financial Services Director's Signature: Nq..i,�,i �. Date: L Ll <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). Approv by Manager N(Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has b e ev' e nd approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: l <br /> County Manager <br /> This contract has been reviewed and is app ved the County Manager Yes /Noo. <br /> This contract has been reviewed a for s n ur t e Ch i Yes No❑. <br /> r <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 /> P,evised March 2012 <br />