HomeMy WebLinkAboutR 2013-094 Health - State of NC for Maintaining a nd promoting the advancement of public health in NC 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: State of North Carolina Party/Vendor Contact Person: State Health Director Contact Phone: 919-707-5000
Party/Vendor Address:5605 Six Forks Road City Ralei h State:NC Zip:27609 Department:Public Health Amount:NIA Purpose:
Maintaining and promoting_the advancement of public health in North Carolina Budget Code(s):N/A Vendor#NA (N/A if new
vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective
Date July 1,2013 Approved by Board Yes❑Non Agenda Date: Title of Contract:North Carolina Department of Health
and Human Services Consolidated Agreement
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes®Na❑. If submitted for bid were
bidstRFPs received Yes❑Non BidtRFP number This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date: ,� 1
" IT irector
(Applicable only to hardware/software p o a laced servic is contract has been reviewed and approved by the Information
Technology Director as to technical content and informa 1mc2lo`specifications:
IT Director's Signature: `~. Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required V. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager. f��
Risk Manager's Signature: l,( � � J� Date: �r r u
Financial Services
This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑Nog./ A budget amendment is necessary
before approval Yes❑NoY. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Buddgfeet and Fiscal Control Act:
Financial Services Director's Signature: U( t f.-� A AV, Date: 2d-I,
County Attorney
Approval by Board M(Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or apy BOCC
consultant contract). Approval by Manager❑(Most other contracts$1,000 and above). Department Director approval only '(Under
$1,000). This contract has be v'ewe roved by the Attorney as to legal form and suffi ' c :
KUC ccppmrct{ or7u I j st5n $ 231z_tt>1 l
Attorney's Signature Date. 3
County Manager
This contract has been reviewed and is approved by the County Managerr,X�eg-, No❑.
This contract has been reviewed and ' g y hair Yel ob �y
Manager's Signature: ate:
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