R 2013-487 EMS - University of NC at Chapel Hill for Provision of Medical Direction $51,700

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ORANGE COUNTY—CONTRACT CONTROL SHEET Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: The University of North Carolina at Chapel Hill Party/Vendor Contact Person: Kenyetta Hall Contact Phone:919) 843-0308 Party/Vendor Address: CB#7594 170 Manning Drive,Physicians Office Bldg. City Chapel Hill State:NC Zip:27514 Department:Emergency Medicine Amount: 51,700 Purpose:Provision of Medical Direction Budget Code(s): 10757520 630000 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes❑.No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date July 1,2013 Approved by Board Yes❑No® Agenda Date: Title of Contract:An Agreement to provide emergency medical director services If this is a Grant Agreement,pre-application has been approve by the Board of Commissioners Yes❑No❑. If submitted for bid were bids/RFPs received Yes❑No❑ Bid/RFP ber T contract has been reviewed and approved by the Department Director as to technical content: , Department Director's Signature: Date: qQ IT Director (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk Management Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved by the Risk Manager: Risk Mana pr's Signature: k� Date: I�IZZ Financial Services This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No: A budget amendment is necessary before approval Yes❑No[If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: n Financial Services Director's Signature: l/ q'41 .U, Date: ?4_7 County Attorney Approval by Board ❑ (Contracts, ver $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant contract). Approval by Manager Qq(All other contracts). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorney's Signature Date: rd a County Managcr This contract has been reviewed and is pro by the County Manager Yes No❑. This contract has been reviewed i be u mi d or c ideration Yes❑No❑. Manager's Signature: Date: Clerk to the Board Approved by BOCC on the i day of 20 . Submitted for Chair signature on the—day of 20 Clerk's Signature: Date: Revised April 2010