HomeMy WebLinkAbout2012-345 S Health - NC State University Industrial Extension Services to Process Development Facilitation $ 1,370 eta -3y5
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
Parry/Vendor Name: North Carolina State University,Industrial Extension Service Party/Vendor Contact Person: Mitch Poteat Contact
Phone: 919-515-5430 Party/Vendor Address:NC State University Box 7902 City Raleigh State:NC Zip:27695 Department:
Health/Environmental Amount: $1,370 Purpose: Process Development Facilitation Budget Code(s):40+19-6 fr Vendor# (N/A if
new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal ❑ Amendment
Effective Date August 15,2012 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 Yos❑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: e/
Department Director's Signature: l Date: d ' �-
I 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 Manazement
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; q
❑ OR No Insurance Required t Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown. this contract i approved
by the Risk Manager:
Risk Manager's Signature: Date: Z
Financial Services
This Contract is conditioned upon 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. This instrument has been pre-audited in the
manner required by the Local Government Bud eett_and Fiscal Control ct: aL
Financial Services Director's Signature: �'' t Date: u (y
County Attorney
Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for co tstruction, or any BOCC consultant
contract). Approval by Manager (All other contracts). This contract has bee reviewed and approved by the Attorney as to legal
form and sufficiency: i vy b to l eaA4, J�11r' -f-
;�t
Attorney's Signature Date: " Io
-4- k
County Manager 1
This contract has been reviewed and is approved by the County Manager Yes F_-J'No❑
This contract has been reviewed and is to be s im— onsi deration YesE�P Oz Manager's Signature: Date:
Clerk to the Board l
Approved by BOCC on the_day of --,20--. Submitted for Chair signature on tl[e___day of_ ,20_.____
Clerk's Signature: _ _ Date:____
Revised April 2010