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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: Maximus Consulting Services,Inc. Party/Vendor Contact Person: Jason Jennings Contact Phone: 804.323.3535 <br /> ext. 20 Party/Vendor Address: 804 Moorefield Park Drive, Suite 101 City Richmond, State:Va Zip: 23236 Department: <br /> Amount: 700 Purpose:EMS Cost Report Budget Code(s): 10230020-630000 Vendor# 125825 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 1-5-2011 <br /> Approved by Board Yes❑No® Agenda Date: Title of Contract: EMS Cost Report <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 /> 1� <br /> Department Director's Signature: ����"� ,� A114— Date: I l <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; 2 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: v2 <br /> "C"1 214111 2Origino,S <br /> Financial Services <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No®. A budget 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 Budget and Fiscal Control Act: <br /> l` ."� 'r . /< Date: 2- I1 <br /> Financial Services Director's Signature: t-t" I/ <br /> County Attorney <br /> Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant <br /> contract). Approval by Manager.-❑ (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: <br /> g <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 to be submitted for BOCC cof sideration Yes❑No❑. <br /> Manager's Signature: Date: z <br /> Clerk to the Board <br /> Approved by BOCC on the day of ,20 Submitted for Chair signature on t e day of ,20 <br /> Clerk's Signature: rt `' !'r .J Dater of <br /> Revised April 2010 <br />