R 2014-229 AMS - NCDOT - Drainage/Construction Easement, Agreement - Mt. Willing Rd Bridge Construction Efland NC

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14_ ?2-9 ORANGE COUNTY-CONTRACT CONTROL SHEET C5 2I[Vo o . outing ld 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: NC Department of Transportation Party/Vendor Contact Person: David Moon Contact Phone:336-288-8810 Party/Vendor Address:DOT Right of Way Branch,Division 7, 1101 E. Wendover Ave.,Suite 200 City Greensboro State:NC Zip: 27405 Department:AMS Amount:N/A Purpose:Drainage Easement,Construction Easement,Agreement fo Entry-Mount Willing Road Bridge Construction,Efland NC Budget Code(s): Q L401 '4170 0 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 4/15/2014 Approved by Board Yes®Non Agenda Date:4115114 Title of Contract:N/A 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 number This contract has been reviewed and approved by the Department Director as to technical content: / Department Director's Signature: Date: VC IT Director (Applicable only to hardware/software purchases r r ted services)This contract has been reviewed and approved by the Information Technology Director as to technical content and in ation technology specifications: IT Director's Signature: Date: Risk Manaa2ement 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,JhLs contract is approved by the Risk Manager: Risk Manager's Signature: �\J Date: MAY 14 M4 Financial Services This Contract is conditioned 0on appropriation by the Board of Commissioners Yes❑No[( A budg Rimendment is necessary before approval Yes❑NoIf budget amendment is necessary,please attach to this form. This instrument has een - manner required by the Local Government Budget and Fiscal Control Act: / Financial Services Director's Signature: �p G1_� Date: f � County Attorney Approval by Board 4? (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 has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorney's Signature f Date: County Manager This contract has been reviewed and is a rov a County Manager Yes"❑. This contract has been reviewed an r si y h ' es o❑. 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