HomeMy WebLinkAbout2012-168 S Health - Robert Dupuis for Pharmacy Services $12,397 ZOI Z-4(p)
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
PartyNendor Name: Robert E.Dupuis PartyNendor Contact Person: Robert E. Dupuis Contact Phone: PartyNendor Address:
205 Kenilworth Place City Chapel Hill State:NC Zip:27516 Department:Health Amount: $ Purpose:Provide Pharmacy Services
Budget Code(s): 10414020 630000 Vendor#47361 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No 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 YesE Non. 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: Lint ,;i-k- •r.^"'
Department Director's Signature: Date: 6/Q01 la
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; 0 WC; g Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance p. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: r,Risk Manager's Signature: �• il , Date: (l`
lee c d o G/2 i/ice -1%Y►.a-?o
Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary
before approval Yes❑No If budget amendment is necessary,please attach to this form. his instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Cont of Act: t/
Financial Services Director's Signature: � G+-t�.� Date: GI Z` ( 2
—Pa::.. (.1 Z°I
County Attorney
Approval by Board ❑ (Contract over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Mana_• 1J (All •ther contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Milt -.12./ Date: es--
County Manager
This contract has been reviewed and is approved by the County Manager Yes S N❑.
This contract has been reviewed and is to be ubmitt-+ for BO C consideration Yes❑NoEj
A
Manager's Signature: _ ) )/ / Date: 7— /0 - /Z.-
erk 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 April'2010