HomeMy WebLinkAbout2012-407 S Health - Orange Co Head Start & Early Head Start Services to Children enrolled Ot OCHS/EHS 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: Orange County Head Start and Early Head Start Party/Vendor Contact Person: Angela Wilcox Contact Phone:
919-490-5577 x247 PartyNendor Address: 800 Eastowne Drive City Chapel Hill State:NQ Zip:27514 Department: Health Amount:
Purpose:Health Department Dental Program provides services to children enrolled at OCHS/EHS Budget Code(s):_
Vendor#- (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check one)New❑ Renewal
[D Amendment F-1 Effective Date- Approved by Board Yes❑No❑ Agenda Date: Title of Contract:Agreement
with Dental Services for Orange County Head Start and Early Head Start
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: k Date: IL20
Z
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; F-1 WC; ❑ Professional; F-1 Property; OR No Insurance Required � Hold
Contract pending receipt of Certificate of Insurance Fl. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: k y Date: 2-
Financial Services
This Contract is conditioned appropriation by the Board of Commissioners YesE]Nov A budget amendment is necessary
[_1 _2ypon ap
before approval Yes❑Nol�4. 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 olAct:
Financial Services Director's Signature: Date:
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manager❑ (Most other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency:
Attorney's SignatuA ks" Date:
County Manager
This contract has been reviewed and is approved by the County Manager YesC Non.
This contract has been reviewed and is for signature by th hair Yes❑NoE2-`_
Manager's Signature: Date:
lerk 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