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ORANGE COUNTY—CONTRACT CONTROL SHEET D <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: UNC Faculty Physicians Party/Vendor Contact Person: KatWjn Grant Contact Phone: 984-974-1274 [ <br /> Party/Vendor Address:211 Friday Center Drive City Chapel Hill State:NC Zip:27517 Department:Health Amount: $4,000V$�pose: <br /> Services related to BCCCP program. Budget Codes 0412020-631010-7140 endor#21680 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes❑No® Contract Type: (C eck one)New❑ Renei ,'N Amendment ❑ Effective Date 7-1-16 Approved <br /> by Board Yes❑Non Agenda Date: Title of Contract:UNC BCCCP Program. <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❑Nor-1 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 D ctor <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; E] WC; E] Professional; E] Property; OR No Insurance Required E]. Hold <br /> Contract pending receipt of Certificate of Insurance R. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: C; <br /> ���__ <br /> Risk Manager's Signature: Date: 4 <br /> �-� <br /> Financial Services <br /> This Contract is conditioned upon appropriation by t Board of Commissioners this fo�N s instrument has been pre-audited in the <br /> before approval Yes❑No❑. If budget amendme s nec ,p <br /> manner required by the Local Government Budget Fis C ntro ct: <br /> Date: <br /> Financial Services Director's Signature: <br /> County Attorney <br /> Approval by Board El (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 0 as 0 ndalbove and Department ie Director approval only❑ (Under <br /> $1,000). This contract has been re 1 w d an oved by the y <br /> Date: <br /> Attorney's Signature <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes❑No❑. <br /> This contract has been reviewed and is for signature by the Chair Yes❑No❑. <br /> Date: <br /> Manager's Signature: <br /> Clerk to the Board ,20 <br /> Approved by BOCC on the_day of bmitted for Chair signature on the_day of <br /> Date: 7 <br /> Clerk's Signature: <br /> Revised March 2012 <br />