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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: Hos ira Party/Vendor Contact Person: John Spellman Contact Phone: Party/Vendor Address:275 North <br /> Field Dept. 361 bldg. H1 Drive City Lake Forest State: IL Zip: 60045 Department: Public Health Amount: 2,K610 Purpose: <br /> Provider will provide OCHD with specified products at a past-through cost Budget Code(s): 10412020-680075 Vendor#N/A (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ <br /> Effective Date January 1,2014 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Injectable Pharmaceuticals <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❑Nor-1 Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> c <br /> Department Director's Signature: Date: <br /> hT 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 /> 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: <br /> Risk Manager's Signature: / Date: t l <br /> Z-l7 <br /> Financial Services <br /> This Contract is conditioned iyon appropriation by the Board of Commissioners Yes❑No 91* A budget amendment is necessary <br /> before approval Yes❑NoLy. 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: u *.-_- Date: <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 b Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has bee r vie and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: D (is a M <br /> County Manager FEB -7 M3 <br /> This contract has been reviewed and is appro ed by the County Manager Yes to❑. <br /> This contract has been reviewed a is r ature the it s❑No❑. <br /> d y 8 gw� <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 />