HomeMy WebLinkAbout2012-198 S Health - Dr Theodore Oldenburg for Dental Services $35,000 1L- ic-t, S` d
ORANGE COUNTY-CONTRACT CONTROL SHEET
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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
PartyNendor Name: Dr. Theodore Oldenburg PartyNendor Contact Person: Dr. Theodore Oldenburg Contact Phone:
PartyNendor Address:734 Cedar Club Circle City Chapel Hill State:NC Zip:27517 Department: Health Amount: $700/clinic-not to
exceed$35,000 for the year Purpose: Provide Dental Services to Clients Budget Code(s): 10410120 630000 Vendor#37639 (N/A if
new vendor) Vendor is a BOCC consultant? Yes❑No11 Contract Type: (Check one)New ❑ Renewal // Amendment ❑
Effective Date July 1,2012 Approved by Board Yes❑No❑ Agenda Date: Title of Contract:
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 This contract has been reviewed and approved by the Department Director as to
technical content: ��/�,� �- Q
Department Director's Signature: �ifiG�-�— . � Date: e�l
/10-
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 1VI agement
Include the following coverages: ❑ CGL; ❑ Auto;JD
WC; 91 Professional; ❑ Property; OR No Insurance Required O. 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: Cea '-A_- .1 Date: fit 911 2-
Financial Services
This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑Nok'. A budget amendment is necessary
before approval Yes❑ NoK. 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 nd Fiscal Control Act:
Financial Services Director's Signature: ter , ,,..--- Date: ?/VI--
County Attorney
Approval by Board ❑ (Contracts $90,000 00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval e Manager[(Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has be iewe�i dLpproved by the Attorney as to legal form and suffici cy:
Attorney's Signature '4, �, Date: a.
County Manager
This contract has been reviewed and is approved by the County Manager Yes o❑.
This contract has been reviewed and is for sit re b, the . air Yes❑No2'
6j I 0 AM Date: 7 �v ' �
Manager's Signature: _
Clerk to the Board,
Approved by BOCC on the^day of ,20 . Submitted for Chair signature on the day of_ ,20
Clerk's Signature: _ Date:
Revised March 2012
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