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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: University of North Carolina Hospitals Party/Vendor Contact Person: Susan Blalock Contact Phone:919-966- <br /> 3887 Party/Vendor Address: 101 Manning,Drive City Cha ep 1 Hill State:Nc Zip:27514 Department: Aging Amount: $25,000 <br /> Purpose:Wellness Program Director support Budget Code(s):29430305-499999 Vendor#40132 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/2013 <br /> Approved by Board Yes❑No® Agenda Date: Title of Contract: UNCH#649 <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 ass h c jr�tT a t o <br /> by the Risk Manager: U� LL55 �!JJ (� <br /> Risk Manager's Signature: ,( �� �_ Date: Z <br /> APR 16 2014 I,I' <br /> Financial Services <br /> This Contract is conditioned/ <br /> on appropriation by the Board of Commissioners Yes❑No[9. A buaget amendment is necessary <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 Bud et and Fiscal Control)c,:g Financial Services Director's Si nature: ^�` " Date: <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 b evie d and approved by the Attorney as to legal form and su'flficienc <br /> Attorney's Signature Date: `L 4, <br /> County Manager <br /> This contract has been reviewed and is ap ove y the County Manager Yes No❑. <br /> This contract has been reviewed f si e b t it Y s❑No❑. <br /> Manager's Signature: Date: <br /> (�f 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: 1 <br /> Revised March 2012 <br />