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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: UNC Department of Family Medicine Party/Vendor Contact Person: Kathryn Grant Contact Phone: 984-974-1274 <br /> Party/Vendor Address:211 Friday Center Drive City ghqpel Hill State:NC Zip:27517 Department:Health Amount: $145,416 <br /> Purpose:Medical Director Services Budget Code(s)%L0414020-630000-71400/71403/71406/71409/71414/714-16 Vendor#21243 (N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:�eckvffe)Nev-❑ Irenewa Amendment ❑ <br /> Effective Date 7-1-16 Approved by Board Yes❑No❑ Agenda Date: Title of Contract:Medical Director <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: 'Uh- 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 shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: Date: <br /> Financial Services <br /> This Contract is conditioned upon appropriation by Bo d of Co issioners Yes❑No❑. A budget amendment is necessary <br /> before approval Yes❑No❑. If budget amendme s ne ,p ase attach to this form. This instrument has been pre-audited in the <br /> manner required by the Local Government Budget n Fi " 1 ontr Act: <br /> Financial Services Director's Signature: Date: `O 6 <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 Mana er (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has be n r vie d approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: tJot i <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 /> Manager's Signature: Date: <br /> Clerk to the Board <br /> Approved by BOCC on the day of 20 . Sub 'tted for Chair signature on the day of 120 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />