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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: Cynthia Gamble Party/Vendor Contact Person: Cynthia Gamble Contact Phone: 919-380-1042 Party/Vendor <br /> Address: 114 Oakmist Dr City Cam State:NC Zip:27513 Department:Public Health Amount: $11,200 Purpose:Provider will render <br /> professional dental services patient care at the OCHD clinics Budget Code(s): 10410120-630000 Vendor#59544 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective Date Ju�L <br /> 2014 Approved by Board Yes❑No❑ Agenda Date:July 1 2014-June 30,2015 Title of Contract: Cynthia Gamble <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: 1 <br /> Department Director's Signature: e Date: <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 /> 1 r nature: Date: <br /> Ris ement <br /> Include the following coverages: ❑ C Professional; ❑ Property; OR No Insurance Required ❑. Hold <br /> Contract pending re ertificate of Insurance ❑. With incorporatio nce provisions as sho FA—U s PbnTc0isTppM <br /> b anager: �C �J �j LC Risk Manager's Signature: � %�� — Date G 2 5 2014 <br /> 8l zs <br /> Financial Services By <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No A budget amen t e <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 mt And F-is-cal C'ontrol t: <br /> Financial Services Director's Signature: �Jl G�G�IN Date: <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000. 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval by an erq(Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has been rev e and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manauer <br /> This contract has been reviewed and is approved by the County Manager Yes61o❑. <br /> This contract has been reviewed and' r si nature b the Chair No❑. ! <br /> Manager's Signature: Date: <br /> Clerk to the Board <br /> Approved by BOCC on the_day of ,20 . Sub fa Chair signature on th _day of ,20 <br /> Clerk's Signature: Date: � <br /> Revised March 2012 <br />