HomeMy WebLinkAboutR 2013-081 Health - UNC Dept of Family Medicine School Of Medicine Tobacco Treatment SSpecialist $12,000 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.
10 41 L4 0 e_*0 Co3 03--.10
Department
Party/Vendor Name: UNC Dept of Family Medicine School of Medicine Party/Vendor Contact erson: Warren P.Newton,MD
Contact Phone: Party/Vendor�Address: 590 Manning Drive City Chapel Hill State:NQ ip: 27599 Department:UNC Dept of
Family Medicine Amount-;/,f2.000 'J, Fpose:Tabasco Treatment Specialist Budget Code(s): Vendor#21243 (N/A if new
vendor) Vendor is a BObC—cods'ultant? Yes❑Noo Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective
Date February 1,2013 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:
Department Director's Signature: Date:
IT Director
(Applicable only to hardwarelsoftware 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 Require � 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: d4a,_,4, Date:
Financial Services
This Contract is conditioned lipon appropriation by the Board of Commissioners Yes❑No[g� A budget amendment is necessary
before approval YesEl Nog. 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:_U41141� /J. A,- Date:
County Attorney
Approval by Board ❑ (Contracts $90,000,,09 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approv yMan Ver�a�(M�ost other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has*evie d d approved by the Attorney as to legal form and sufficiqncy-
Attorney's Signature- Date: 351
County Manager
This contract has been reviewed and is approved by the County Manager Ye$Eallon.
This contract has been reviewed and is for signature by the Chair YesF]No[D'—
Manager's Signature: Date:
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