R 2010-045 Health - Chapel Hill Carrboro Schools nurses

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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: Chapel Hill Carrboro City Schools Party/Vendor Contact Person: Stephanie Willis, School Nurse Supervisor Contact Phone: 967-8211 x 245 Party/Vendor Address: 750 S.Merritt Mill Road City Chapel Hill State:NC Zip: 27516 Department: Amount:428,032 Purpose: Budget Code(s): (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New W, enewal Amendment ❑ Effective Date 7/1/2010 Approved by Board Yes®No❑ Agenda Date: 6/15/10 Title of Contract: eement for School Nursing Services If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners Yes No If submitted forbid 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 Signature: Date: IT Director (Applicable only to hardware/software purchases 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 Management Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance ❑. 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 YesE�NoN. A budget amendment is necessary before approval Yes❑NoM. 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: l,C w o A''' Date: County Attorney Approval by Board K(Contracts 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: Attorney's Signature Date: 1-112.010 County Manager 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 Submitted for Chair signature: Clerk's Signature: Date: Revised December 2009