Orange County NC Website
Browse       Search
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: Wake Radiology Diagnostic Imaging,Inc Party/Vendor Contact Person: Lyndon K.Jordan III Contact Phone: <br /> Party/Vendor Address: 3949 Browning Place City Raleigh State:NC Zip:27609 Department:Public Health Amount: $6,400 <br /> Purpose: Provider will provide X-rU services to patients referred by the OCHD Budget Code(s): 10414020-63 1010 Vendor#27691 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal ® Amendment <br /> ❑ Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date: July 1,2014-June 30,2015 Title of Contract: <br /> Wake Radiology BCCCP <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: �d" <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 sh , <br /> by the Risk Manager: D <br /> Risk Manager's Signature: Date: OCT 1 Q 2014 <br /> 161b <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[� A b <br /> before approval Yes❑No[MIf 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 Contr 1 Act: <br /> Financial Services Director's Signature: . /r '"'� Date: 101 <br /> 101�� <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 by Manager ],(Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has been rev' e an roved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes Rio❑. <br /> This contract has been reviewed and i for s gnature b the Chair Yes❑No❑. / <br /> Manager's Signature: Date:-/ ` S l) <br /> Lt <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 />