Orange County NC Website
Browse       Search
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 Party/Vendor Contact Person: Janice Summers Contact Phone: Party/Vendor Address:UNC City <br /> State: Zip: Department:DSS Amount: $55,562 Purpose:reimbursement for intake worker and supervisor Budget <br /> Code(s): Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New <br /> ❑ Renewal® Amendment ❑ Effective Date 07/01/10 Approved by Board Yes®No❑ Agenda Date: Title of <br /> Contract: Medicaid intake workers at UNC <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: f Date: C)-j <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; ❑ 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: <br /> Financial Services <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑N& A budget amendment is necessary <br /> before approval Yes❑No'1. 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 /> 1 <br /> Financial Services Director's Signature: (G `L` �^'�", Date: d? �'1 f <br /> l <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 b SMvagerF] (All other contracts). This contract has been reviewed and approved by the Attorney as to legal <br /> form and sufficiency: 4 <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 consideration Yes❑No❑. <br /> Manager's Signature: Date: <br /> VA11100"_ <br /> Clerk to the Board <br /> Approved by BOCC on the of ,20 Submitted for Chair signature on the day of ,20 <br /> Clerk's Signature: Date: <br /> Revised April 2010 <br />