HomeMy WebLinkAboutR 2013-190 Health - Wake Radiology Diagnostic Imaging to Provide mammography services and meet the Center of Disease's standerdized requirements $6,400 -
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ORANGE COUNTY—CONTRACT CONTROL SHEET
Routing Order: (l)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. lf the Manager
dctenoines the contract{a not appropriate for Manager approval the Manager shall submit the contract for 0OCCapproval. 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
Panym/ondorl«umc: Wake Radiology Diagnostic Imaging,LCC Party/Vendor Contact Person: Robert E. Schaaf Contact Phone:919-
787-8221 Pucty/Vaodo,/\ddrcme: 3949 Browning Place City Raleigh State:NC Zip:27609 Department: Public 8eddl Amount:
$6,40U0 Budget Code(s):
680018 Vendor#819629 (N/A if new vendor) Vendor is a BOCC consultant? Yes M NoE Contract Type:(Check one)New
Renewal Amendment M Effective Date July l, I013 Approved hyBoard `yra[]I4o[] Agenda Date: Title of
Contract: Wake Radiology BCCCP
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners YeuElNmEl. lf submitted for bid were
bids/RFPs received ycuFlNuM 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
(A/),/icob/a only to hard&war s urchases or related his contract has been reviewed and approved by the lo;mouubon
Technology Director as to technical conten ation technology specifications:
IT Director's Signat —Date-:
Risk Management
Include the following coverages: E] CGL; M &mm; El WC; F1 Professional; M Property; 00 No Insurance Required [I. Bold
Contract pending receipt o[CcrtifioateofInsurance []. With incorporation mf Insurance provisions uy shown,this contract iaapproved
hy the Risk Manager:
Risk Manager's Signature: Date: q1d13
_ —_'' .A. ^^.`'
Financial Services
This Contract imoouddiomd Won appropriation hy the Board ofCommissioners yeyoNom & budget amendment ianecessary
before approval }'euElNoLV. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required bythe Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature: ,]Al,,— Date:
County Attorney
Approval by Board Fl ( $90000construction, or any 8OCC
ooumo|tao t) | nager[Y(Most other contracts$1,000 and . Depm�mneutDimz¢ruppoomdonly[l(Under
$l,0OO). 7hiacoo�auL has been wed d approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County This contract has been,ovievvodand ia approved by the County Manugcr .
This contract b 6 d FI 03^
Manager's Signature: �r
Clerk to the Board
Approved hyB0CCou the__.day of2O____. Submitted for Chair signature un the day of 20___
Clerk's Signature: Date:
Revised March 2012