HomeMy WebLinkAbout2012-259 S Health - Ginger Mann for Program Coordinator for Smart Smiles Dental Screening Ed & Referrral Program for young children $ 14,500 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: Ginger Mann PartyNendor Contact Person: Ginger Mann Conta 'hone: PartyNendor Address: 5437
Stewartby Drive City Raleigh State:NC Zip:27613 Department:Health Amount: 4,500 Purpose: Program Coordinator for
Smart Smiles Dental Screening,Education and Referral Program for Young Children e-=': Code(s): 10410020 630000 Vendor#
43826 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No Contract Type: (Check one)New❑ Renewal
Amendment El 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❑Non. If submitted for bid were
bids/RFPs received Yes❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content: See
t. --.Director's Signature: S!w"-- 5.1c1.6,,.. Date: i iirllla
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:
f Risk Management
Include the following coverages: [VJ CGL; Id Auto; WC; El Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance . With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: r JJ// fi Risk Manager's Signature: '` , 4'4-- Date: _427
iL. i711'i11.
Financial Services
This Contract is conditions upon appropriation by the Board of Commissioners Yes❑No . A budget amendment is necessary
before approval Yes❑ No[l]. 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 and Fiscal Control Act:
(q�(` , JI�J''`� if 2b Il/f-
Financial Services Director's Signature: �.� Date:
County Attorney
Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Mai •ger 1�/ (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency: ' /
Attorney's Signature �1�__. Date:i 12-
County Manager
This contract has been reviewed and is approved by the County Manager Yeallo❑.
This contract has been reviewed and is to be ;i• i,-• f.r :,I CC consideration Yes❑NQO-
/ / �
Manager's Signature: _ II `r�4 Date: 7- �'
V. ,•�k 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