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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: Orange Public Transportation Party/Vendor Contact Person: Peter Murphv Contact Phone:919-245-2002 <br /> Party/Vendor Address: 600 Public Works Dr City Hillsborough State:NC Zip:27278 Department:DSS Amount: $12.75 per one-way <br /> bip Purpose:Medicaid Transportation Budget Code(s): Vendor#_ (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes❑No❑ Contract Type: (Check one)New❑ Renewal 0 Amendment ❑ Effective Date 7/1/2014 Approved by Board Yes <br /> F-1 No❑ Agenda Date: Title of Contract:Medicaid Transportation Memorandum of Understanding <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:6� Date: C7 t <br /> IT 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 Ins aMice Recluired El. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shoi It�nflcpsFq!,_eA <br /> by the Risk Manager: <br /> Risk Manager's Signature: Date: 7 JUL 16 2 <br /> A"/ W <br /> L-117 N <br /> Financial Services By <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No❑. A budget amendment is necessary <br /> before approval Yes❑No❑. If budget amendment is necessary,please attach to this form. This I nt hE.,s bqen pre-audited in the <br /> manner required by the Local Govermne B get and Fiscal Contr,olikct: <br /> Financial Services Director's Signat ae:, ate• <br /> .V <br /> County Attorney V Oro <br /> ir,s rume <br /> ,:-17C 11 t <br /> SW ;f Z/9,e <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 anager❑ (Most other contracts$1,000 and above). Department Director approval on (Under <br /> e <br /> $1,000). This contract has been e * ed and approved by the Attorney as to legal form and sufficie cy: lyl� <br /> Attorney's Signature M Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YesV-1No❑. <br /> This contract has been reviewed and is, r signature by the Chair Yes❑No❑. <br /> Manager's Signature: Date: 7/ <br /> Clerk to` Board <br /> Approved by BOCC on the—day of 20 . Submitted for Chair signature on the_day of <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />