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e4— J4(o(3 <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 /> PartyNendor Name: Piedmont Health Services Party/Vendor Contact Person: Brian Toomey Contact Phone: 919-933-8494 <br /> Party/Vendor Address:229 Lloyd Street City Carrboro State:NC Zip:27510 Department: Public Health Amount:N/A Purpose: PHS <br /> and OCHD agree for certification of WIC clients at OCHD Budget Code(s):N/A Vendor#27898 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date July 1,2014 <br /> Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Piedmont Health Services WIC Program and Oran <br /> County Health Department For WIC Program Services <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: <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 Insurance Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as show , <br /> by the Risk Manager: D Mq TY <br /> Risk Manager's Signature: Date: 1616LI1§4 AUG 2 0 2014 <br /> 8i Zl <br /> Financial Services y <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No� A bud <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 Budget and Fiscal Con of Act-. <br /> Financial Services Director's Signature: G�'K �/' �` Date: �b <br /> 101111 <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 bK Manager W(Most other contracts$1,000 and above). Department Director approval only (Under <br /> $1,000). This contract has been ke iewed and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: ! 1:5-) 14 <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes❑Nor-1. <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 />