R 2014-483 Health - UNC-Chapel Hill - services in re to medical director services, general consultation, clinical services

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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: The University of North Carolina at Cha ep 1 Hill Party/Vendor Contact Person: Warren P.Newton Contact Phone: 919-966-0210 Party/Vendor Address: 590 Manning Drive City Cha ep 1 Hill State:NC Zip:27599 Department: Public Health Amount: $145,416 Purpose: Provider will render services in reference to medical director services general consultation and clinical services Budget Code(s): 10414020-630000 Vendor#21243 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New ❑ Renewal® Amendment ❑ Effective Date July 1,2014 Approved by Board Yes®No❑ A ends Date: July 1,2014-June 30,2015 Title of Contract:Unc Family of Medicine Service Agreement ��'% If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No[- If submitte 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: � 7 (f Department Director's Signature: Date: 3 ' l / IT hector (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 showFLSEP9 roved by the Risk Manager:Risk Manager's Signature: � Date: J 4 Financial Services This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[R( A budg c ary before approval Yes❑ No(. If budget amendment is necessary,please attach to this form. This instrument has been pre-au ite m t e manner required by the Local Government Budget and Fiscal Control Act: Financial Services Director's Signature: w�L�-G✓ Date: /oft r 119 County Attorney Approval by Board ❑ (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 oval only❑ (Under. L $1,000 . This contract has been re e ed an pproved by the Attorney as to legal form and sufficiency: i JLIX A Lq avl �`i��2ol) Attorney's Signature Date: ((� County Manager This contract has been reviewed and is approved by the County Manager Yes No❑. This contract has been reviewed and is to ignature by the Chair Yes❑No❑. Manager's Signature: Date: !o iy r 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