R 2010-003 Aging - UNC Hospitals wellness coordinator

Browse Search

ORANGE COUNTY-CONTRACT CONTROL SHEET Routing Order: (1)Department, (2)IT,(3)Risk Management,(4)Financial Services, (5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: UNC Hospitals. Party/Vendor Contact Person: Susan Blalock. Contact Phone: 919-966-3887. Party/Vendor Address: 20610 Neurosciences Hospital, 101 Manning Drive. City Chapel Hill. State: NC Zip: 27514 Department: Aging Amount: $25,000 Purpose: Wellness Coordinator Budget Code(s): 294303 Vendor # 30892 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Yes No If submitted for bid were bids/RFPs received Yes❑ No❑. Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: Department Director's Signatur . . Date: /5, 12,rJ IT Director (Applicable only to hardi-vai°e/sofhvare purchase;or related services)This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk ManaLyement Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; ❑ OR No Insurance Required El. Hold Contract pending receipt of Certificate of Insurance F. With incorporation of Insurance provisions as shown, this contract is approved by the Risk Manager: Risk Manager's Signature: Date: Financial Services This Contract is conditioned upon appropriation by the Board of Commissioners Yes�]No❑. A budget amendment is necessary before approval Yes❑ NA]. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Financial Services Director's Signature: a`' -tk ,� Date: 1 County Attorney Approval by Board LIlContracts over $25,000.00 or any BOCC consultant contract). Approval by Manager ❑ (All contracts $25,000.00 or less with the exception of BOCC consultants). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorneys Signature �� Date: C ZI-3 County ManaLyer This contract has been reviewed and is approved by the County Manager Yes❑No❑. This contract has been reviewed and is to be submitted for BOCC consideration Yes❑No❑. Manager's Signature: Date: Clerk to the Board Approved by Board Yes❑No❑ ge Date: Clerk's Signature: Date: /0