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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 Faculty Physicians Party/Vendor Contact Person: Kathryn Grant Contact Phone: Party/Vendor <br /> Address: P.O. Box 168 City Chapel Hill State:NC Zip:27514 Department: Public Health Amount: $6,400 Purpose: Provider will <br /> render services in reference to NC Breast and Cervical Cancer Program Budget Code(s): 10414020-631010 Vendor#21680 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ <br /> Effective Date November 1,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: UNC Faculty <br /> Physicians <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: -t! Date: 1-2��� <br /> I irector <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 /> Risk Manasement <br /> Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate ❑. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: Date: f 2�r <br /> IZJII <br /> Financial Services <br /> This Contract is condi ned upon appropriation by the Board of Commissioners YesZNo❑. A budget amendment is necessary <br /> [ <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: A4,I A Date: 14141s <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 a ager Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has been rev an a ved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is ap !ove y the County a ger Yes[Z No❑. <br /> This contract has been reviewed a s fo ig t re b e s❑No❑. <br /> G <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 120 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />