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ORANGE COUNTY—CONTRACT CONTROL SHEET �U 1 7 <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 /> e artment <br /> Party/Vendor Name: UNC-CH Dept.of Maternal&Child Heal Nendor Contact Person: Lisa Perry Contact Phone:919-966- <br /> 82 Party/Vendor Address: CB 7445,401B Rosenau Hall ity Chapel Hill State:NC Zip:27599-7445 Department:Health Amount: <br /> 35 672 Purpose:Interim Health Director Budget Code(V10410020-630000 Vendor# 10419/R30 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 2-24-17 <br /> Approved by Board Yes❑Non Agenda Date: Title of Contract: Interim Health Director Service Agreement <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: S <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:_ � — l[ �� Date: t 117 <br /> Financial Services <br /> This Contract is conditioned upon appropriation by he of Co iss. ners Yes❑No❑. A budget amendment is necessary <br /> before approval Yes❑No❑. If budget amendme is a ess ,p se attach to this form. This instrument has been pre-audited in the <br /> manner required by the Local Government Budget d i al ontr Act: <br /> Financial Services Director's Signature: Date: �/7 <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000.,09 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Appro al y M er (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> $1,000). This contract has en vie ed d approved by the Attorney as to legal form and stiff *ency: <br /> Attorney's Signature Date: <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 2,0 Submitted for Chair signature on the_day of ,20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />