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r <br /> 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: Robert E.Dupuis Party/Vendor Contact Person: Robert E.Dupuis Contact Phone: 919-966-6194 Party/Vendor <br /> Address: 205 Kenilworth Place City Chapel Hill State:NC Zip:27516 Department:Public Health Amount: $12,397 Purpose: Direct <br /> Pharmacy Services at the two pharmacy sites of the Health Department Budget Code(s): 10414020-630000 Vendor#47361 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New N Renewal Amendment ❑ <br /> Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Pharmacy Services 2014-2015 <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: Date: 3- <br /> (Applicable only to hardware ases or related services)This contract has been reviewed and approv(;d by the Information <br /> Technology Director as to technical content and information ec ions: <br /> Risk Management <br /> Include the following coverages: [g,*CGL; ❑ Auto; ❑ WC; 0-11i•ofessional; ❑ Property; OR No Ins au- f—l. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as show [�Kc#a�i flaToT <br /> by the Risk Manager: JJ <br /> Risk Manager's Signature: _ Date: (, JUL 2-1 2014 <br /> Financial Services B', <br /> This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[q/ A budget amendment is necessary <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 Bud gel and Fiscal Con 1 Act: <br /> Financial Services Director's Signature: M4,l,✓ /0' <br /> Date: <br /> 111ZE <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 3,k Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has bee r iew approved by the Attorney as to legal form and suffici ncy <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager YesRf,4oEl <br /> This contract has been reviewed and is for signature by the Chair Yes❑No❑. <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 />