HomeMy WebLinkAbout2012-135 NS Health - NC DDHS $Blank �o iz-13(L ` i
ORANGE COUNTY--CONTRACT CONTROL SHEET ' ' - 4� -
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: DDHS Party/Vendor Contact Person: Laura Gerald State Health Director Contact Phone:Danny Staley
Party/Vendor Address: 1931 Mail Service Center City Raleigh 6ugcDc Zip:27699-1931 Department:NC Division of Public Health
Amount: Purpose: Budget Code(s): 10414020 Vendor#na if new vendor) Vendor is a BOCC consultant? Yes
No0 Contract Type:(Check one)New EJ Renewal 1— Amendment a: Effective Date 7/l/20l2 Approved by Board `ycoFlNu
0 Agenda Date: APPROVED BY THE BOCC ON 8/23/2011 Title of Contract: Amendment to Consolidated Contrac
If this is a Grant Agreement,pre-application has been approved by the Board of C000niominooro`yeo0 Y4n0. If submitted for bid were
bidx/QFPo received Yeu0No0 Qid/RFpoumho, This contract has been reviewed and approved by the Department Director as to
technical content:
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 Management
Include the following coverages: [1] CGL; ri Auto; 0 WC; 0 Professional; 0 Property; OR No Insurance Required D. Hold
Contract pending receipt of Certificate of Insurance 1=1. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date:
• Financial Services
This Contract is d| i Commissioners Yes0Nog. A budget amendment is necessary
before approval l,oxLJ NoLxJ. If budget amendment is naoeoaury, please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Bud � d�i u|Conol&
Financial Services Director's Bigumtmrc /l CK
Date: a id / 2-
County Attorney
Approval by Board 61 (Contracts $90,000.00. or more for goods or services, $250.000.00 or more for ovostrucdoo, or any BOCC
consultant truot) Appno Manager[X(Most other contracts$l0U0 and above). Department Di t |only (Under
$1,000). This contract has b. iewed and approved by the Attorney as to legal form and suffici ncy: iitoc6, a.41.,46z.ezi CA -0)
Attorney's Signature Date: 6? 4 It-
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This contract has bee reviewed and is approved by the County Manager Yesaill No0.
T shis contract has been reviewed and is for signature b the Chair Ye KINoilr-
Manager's Signature: (3)fu-(p Date: 6 - 3- /2-
Approved by BOCC on the 2,3day of Cler ,1 the Board r;71
,20 V itted Chair signature on th- 7 day of a/ ,20 /2-.
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Revised March 2012 r .-Kt,cr\ \ e RI a vl\'Du_n i n
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