R 2014-182 ES - White Cross Fire Volunteer for fire protection

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144--- t ex>__ 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: White Cross Fire Volunteer Party/Vendor Contact Person: Philp Nasser i Contact Phone: 919-942-1149 Party/Vendor Address: 1141 White Cross Rd City Chapel Hill State:NC Zip:27516 Department:Emergency Services Amount: Purpose:Fire Protection Agreement Budget Code(s): Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date Approved by Board Yes® No❑ Agenda Date: 11/19/2013 Title of Contract:Fire Protection and Emergency Services Agreement If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted for bid were bids/RFPs received Yes❑No❑ Bid/RFP numbe This con ct has been reviewed and approved by the Department Director as to technical content: Department Director's Signature: Date: l 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 sTho -] by the Risk Manager:Risk Manager's Signature: Date:Financial Services This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[� A 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: Financial Services Director's Signature: At ��"�- Date: I �tltt County Attorney Approval by Board Pi(Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC consultant contract). Approval by Manager❑ (Most other contracts$1,000 and above). Department Director approval only❑ (Under $1,000). This contract h�viiiewedd proved by the Attorney as to legal form and sufficiency: Attorney's Signature - - Date: County Manager This contract has been reviewed and is appr ve t unty Manager Ye o❑. This contract has been reviewed and is ig re y e it No Manager's Signature: Date Clerk to the Board Approved by BOCC on the_day of ,20 Submitted for Chair signature on the day of 20 Clerk's Signature: Date: Revised March 2012