HomeMy WebLinkAbout2012-079 Health - NC State $508,303 )0L,y- j ORANGE COUNTY-CONTRACT CONTROL SHEET _ ,l <( "
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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 `906 ,`" �\
PartyNendor Name: NC State PartyNendor Contact Person: Billie Matthews Contact Phone:919-707-5120 PartyNendor Address:
Contracts Office City RALEIGH State: NC Zip:27699-1916 Department:CONTRACTS OFFICE Amount: 508303 Purpose: AID
TO COUNTIES Budget Code(s): Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No
Contract Type: (Check one)New❑ Renewal /1 Amendment ❑ Effective Date 7/1/2012 Approved by Board Yes❑ No❑
Agenda Date: 4/3/2012 Title of Contract: RENEWAL OF CONSOLIDATED AGREEMENT
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 Thi ontract has been reviewed and approved by the Department Director as to
technical content: t i
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Department Director's Signature: //. ..0 ,• aV `late: olU 0/A.
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T 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 E Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager: 99
Risk Manager's Signature: ` ' .Date: �' 9' faZ
I!OC 'd 0 3/2 )1 a '7/ U 9 4 47Let c4--6-1 j2-z4 /s/
Financial Services
This Contract is condition d pon appropriation by the Board of Commissioners Yes❑Nol,%. A budget amendment is necessary
before approval Yes❑ No . If budget amendment is necessary,please attach to this form. is instrument has been pre-audited in the
manner required by the Lo Government Budg and Fiscal Contro Act:
if if Z"
Financial Services Director's Signature: a/1/44% t . Date:
County Attorney
Approval by Board ❑ (Contr• • $90,000.90 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval anager Dia(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been 1 ed and approved by the Attorney as to legal form and sufficie cy: ✓D 4.41
Attorney's Signature L2� Date: 4 II !2, h �� "� �'{mil)
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County Manager
This contract has been reviewed and is approved by the County Manager Ye No❑.
This contract has been reviewed and is for signature by the (hair Yes❑N2
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Manager's Signature: ' I/ Dater— Z 1.
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erk to the Board
Approved by BOCC on the_day of r�, •0 7 . .ubmitted for Chair signature on the_day of ,20
Clerk's Signature: Date:
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Revised March 2012