HomeMy WebLinkAbout2012-229 S DSS - UNC Hospitals for Providing a full time Income Maintenance Caseworker $49,587 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
Party/Vendor Name: University of North Carolina Hospitals Party/Vendor Contact Person: Jancie Summers Contact Phone: 919-966-
5 Aa /Ve dor Address: 101 Manning Dr City Chapel Hill State:NC Zip:275]4 Department: DSS Amount: not to exceed
49 58 ose:provide a full time Income Maintenance Caseworker Budget Code(s): Vendor# (N/A if new vendor)
V r is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date
07/01/12 Approved by Board Yes®NOD Agenda Date: Title of Contract:Agreement Between The University of North
Carolina Hospitals and Orange County,North Carolina
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:
Department Director's Signature: G- 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: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ['l 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: � �✓ �. /�'�`� Date: ZA IL
`Iht 111-1
4kz Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[ A budget amendment is necessary
before approval Yes❑ No[A.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:
Financial Services Director's Signature: l�l /J• AU, Date: 7 Zfi
Count Attorne
Approval by Board ❑ (Contracts $90,000.0 ore for goods or services, 000.00 or more for construction, or any BOCC
consultant contract). Approval b ger (Most other cod tracts$1,000 and above). epartment Director approval only❑ (Under
$1,000). This contra r wed and approved by the Attorney as to legal form and s fficienc
Attorney's Signature e: 27
County Manager
This contract has been reviewed and is approved by the County Manager Yes
This contract has been reviewed and is for signature the hair Yes❑No�-
Manager's Signature: Date: 7 /v� 2--
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