HomeMy WebLinkAbout2012-190 S Health - Wake Radiology $per view Charge "Zd!A- y(It)
ORANGE COUNTY—CONTRACT CON17R0D. 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 oumplete,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: Wake Radiology Party/Vendor Contact Person: Michele Jackson Contact Phone: 919-788-7904 9amyNcndnr
Address:3949 Browning Place City Raleigh State: nc Zip: 27609 Department: Health Amount:per view charge Purpose: Chest X-
Ray Budget Code(s): 10414020 631000 Vendor#2769/ (N/A if new vendor) Vendor is a BOCC consultant? Yes 0 No
Contract Type: (Check one)New Fl Renewal Amendment 0 Effective Date 7/1/2012 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 Yco0Y«o0. If submitted for bid were
hido/QFPo received Ycx0No0 Bid/BFPoumhe, This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: 4.-- Date: 2,5-'-(2
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 Mana ement
Include the following coverages: 0 COL; 0 Auto; Ej WC; Professional; 0 Property; OR No Insurance Required O. Hold
Contract pending receipt of Certificate of Insurance E. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
� � z.�•/�~�
��ixkManager's guutorm:~�/0/��l Date: � ",~ �
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Financial Services
This Contract is condition appropriation i by the Board f C i i YvsFN A budget amendment is necessary
before p po va iYua0 �v lfhuotamendment is necessary, please m1uobtnthis form. T s inx�umcnthas been pre-audited in the
ya tild f�manner required by the Local overtunent Budget and Fiscal Control Act:
FiououiuY8crviuew]�imcu0or`y8igoutpre: , ~����� Date: � -
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County Attorney
Approval by Board �� (Contracts $90'008.00 or more for goods or services, $250,000.00 or more for conx�ucioo, or any BOCC
^�
consultant contract). &ppnov by uoa� (Most tb cruo m�ac to$1,000 and above). DepunmcutDirector approval only 0
(Under
�$l.O0O). This oon�ucthas du dn proved hy the&uocuuyaxto legal form uudxuf5c ouy:
lit .
�Attoroxy,s8iguutmre -� �-1". Date: -7 K / -
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County Manager
This contract has been reviewed and is approved by the County Manager `/osp7lHo0.
This contract has been reviewed and is for signature by the Cha. l/esFlNn[a.'
Manager's Signature: DAL /
Datc:7
—/6.-/ Z.-
Clerk to the Board
/\ppnovcdbyB0CCondhedayof .20 . Submitted for Chair signature on the day of ,20 .
Clerk's Signature: Date:
Revised March 2012