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10� <br /> 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 at Chapel Hill Party/Vendor Contact Person: Brenda Cooper Contact Phone: (919) <br /> 843-0308 Party/Vendor Address: CB#7594 170 Manning Drive,Physicians Office Bldg City Chapel Hill State:NC Zip:27599-7594 <br /> O�s�52 <br /> Department: Emergency Services Amount:47,000 Purpose:M ical Director Services Budget Code(s): 63ov dor#-2.L.1-60(N/A <br /> if new vendor) Vendor is a BOCC consultant? Yes❑No[�Contract Type: (Check one)New❑ Renewal Amendment ❑ <br /> Effective Date 07/01/10 Approved by Board Yes❑No❑ Agenda Date: R/A- Title of Contract: An Agreement to Provide <br /> Emergency Medical Director Services <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: AA Date: <br /> IT Director <br /> (Applicable only to hard vare/sofhvare 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 El. Hold <br /> Contract pending receipt of Certificate of Insurance El. 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 the Board of Commissioners Yes❑No A budget amendment is necessary <br /> before approval Yes❑NoV. 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 /> Financial Services Director's Signature: d64%44--- 0 14 AAR fz))10 y Date: <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 Maria (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: ` l <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 BOC c sideratiion Yes❑`No❑. <br /> Manager's Signature: Date: <br /> Clerk to the Board <br /> Approved by BOCC on the day o 20 Submitted for Chair signature on the day of ,20 <br /> Clerk's Signature: Date: Q <br /> dl - <br /> L S f' <br /> Revised April 2010 <br /> l� <br />