HomeMy WebLinkAbout2012-324 S Health - UNC Family Medicine for Medical Director/Physician Services for Health Dept $145,416 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: UNC Family Medicine Party/Vendor Contact Person: Ron Linsley Contact Phone:919-966-1200 Party/Vendor
Address: 590 Manning Drive City Chgpel Hill State:NC Zip:27514 Department: Health Amount: 145,416 Purpose: Medical
Director/Physician Services for Health Department Budget Code(s): 10414020 630000 Vendor#21243 (N/A if new vendor) Vendor
is a BOCC consultant? Yes ❑NoE Contract Type: (Check one)New El Renewal Z Amendment F-1 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❑ 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: DateV I q 1)
IT Director
(Applicable only to hardvvarelsojtware purchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to technical cor"-mt and information technology specifications:
IT Director's Signature: ------ Date:
Risk Ma!3agement
Include the following coverages: ❑ CGL; ❑ Aul'o; Q WC; 9 Professional; [:1 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:
Risk Manager's Signature: & Date: 241 12-
�
Financial Services
This Contract is conditioned hon appropriation by the Board of Commissioners YesE]Nol/ A budget amendment is necessary
before approval Yes❑No[g. 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 Con I Act*
Financial Services Director's Signature: (Y"Clu_ o PJt-,� Date: V ul ��"'
Countv Attorney
Approval by Board ❑ (Conti-acts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval Department nap-Cr&(most other contracts$1,000 and above). Depament Director approval only F1 (Under
,t has b
$1,004 This contract I ewe, an a roved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: 101
County Manager
This contract has been reviewed and is approved by the County Yanager Ye NoLl.—
This contract has been reviewed and is for signature by esFINov
Manager's Signature: 190 Date: 2
It V UIL
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