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il� <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: UNC Hospitals Party/Vendor Contact Person: Susan Blalock Contact Phone: 966-3887 Party/Vendor Address: <br /> 20610 Neurosciences Hospital, 101 Manning Drive City Chapel Hill State:NC Zip:27514 Department:Aging Amount: $25,000 <br /> Purpose:Wellness Program Coordinator Budget Code(s): 29430305-499999 Vendor#30892 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/10 Approved by <br /> Board Yes®No❑ Agenda Date: included in FYI budget 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: f I f_n <br /> IT Director <br /> (Applicable only to hardware/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; [l 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: ' Z 3 •�� <br /> Rat'd if/o/to <br /> Financial Services <br /> This Contract is conditione pon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary <br /> before approval Yes❑ No[N. If budget amendment is necessary,please attach to this form. T is instrument has been pre-audited in the <br /> manner required by the Local Government Bud et and Fiscal Control Act: <br /> ly <br /> Financial Services Director's Signature: �� Date: <br /> County Attorney <br /> Approval by Board 4 (Contract 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 /> Attorney's Signature Date: a Gb <br /> County Man�er � <br /> This contract has been reviewed and is approved by the County Manager o❑. <br /> T his contract has been reviewed and is to be submitted for B C consideration Yes❑N�0 - <br /> Manager's Signature: Date: l <br /> U <br /> Jerk to the Board <br /> Approved by BOCC on the dvTqf 5201 Submitted for Chair signature on the day of ,20 <br /> Clerk's Signature: Date: <br /> ,/kz cQ aka1 0 <br /> Revised April 2010 <br />