HomeMy WebLinkAbout2012-199 S Health - Piedmont Health Services for Registered Dietitian Services $30,500 ` . �
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ORANGE 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: Piedmont Health Services Party/Vendor Contact Person: Brian Toomey Contact Phone: 919-933-8494
Party/Vendor Address: 299 Lloyd St City Carrboro State:NC Zip:27510 Department: Health Amount: $30,500 Purpose: Provide
Registered Dietitian Services Budget Code( 10412010 Vendor#27898 /A if new vendor) Vendor is a BOCC consultant? Yes
No 1 Contract Type: (Check one)New Renewal Amendment 1:1 Effective Date 7/l/20|2 Approved by Board YesE No
Z Agenda Date: Title of Contract: Registered Dietitian Services Agreement.
If this is a Grant Agreement, pre-application has been approved by the Board of Commissioners YnoEjNo[l. If submitted for bid were
bido/BFPs received YeoZY4oZ Did/RFPnumhc, This contract has been reviewed and approved by the Department Director as to
technical conten -
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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 Ma5agement
Include the following coverages: 0 CGL; 0 Auto; El WC; ISVPruh:ooiooa\; 0 Property; OR No Insurance Required Z. Hold
Contract pending receipt of Certificate of Insurance Z. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: q°^44„ ~ " A~- Date: 1121
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Financial Services
This Contract is condition-" onn appropriation by the Board of Commissioners Yem[jl4 oV. A budget amendment is necessary
before approval YeoZ No If budget amendment is necessary, please attach to this (b///.. This instrument has been pre-audited in the
manner required by the Local Government Bud t and
Services Director's Signature: /� Date: �Y ,/i 2-
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County Attorney
Approval by Board Z $90,000.00 for goods or services, $250,000.00 or more for oonmzumion, or any BOCC
consultant contract). Approva by Manager(Most other contracts$1,000 and above). Department Director approval only Z (Under
0$\.O0O). This contract has b '"io" n�approved hythe&uorocyus,u legal form and suffi � :
Attorney's Signature Il Date: 1 6)
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County Manager
This contract has been reviewed and is approved by the County Manager YxEli\lo0.
This contract has been reviewed and is f by h Chair yoa0Nor-~
� � Date: -/M , y
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Manager's Signature:
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Clerk to the Board
Approved by BOCC on the day of ,20 . 8ubmittedh/rCbuirxiguumpcondbedayof ,20 .
Clerk's Signature: Date:
Revised March 2012