HomeMy WebLinkAboutR 2013-256 Health - Robert E Dupuis for Direct Pharmacy Services at the two pharmacy sites of the Health Dept $12,397 131 �5� 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: Robert E. Dupuis Party/Vendor Contact Person: Robert E. Dupuis Contact Phone: 919-966-6 artyNendor
Address: 205 Kenilworth Place City Chapel Hill State:NC. Zip: 27516 Department: Public Health Amount: $-1�L,397 ,urpose: Direct
Pharmacy Services at the two pharmacy sites of the Health D=partxrnen1 Budget Code(s): 10414020-63000 'Vend - "N/A (N/A if new
vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal mendment ❑ Effective
Date July 1,2013 Approved by Board Yes[]No❑ Agenda Date: Title of Contract: Pharmacy Services 2013-2014
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:
s
Department Director's Signature: Date:
(App is re/so tware purchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to technical content and information tec no ogy spec> >ca tons.
� ec ors _ Date:
Risk Ma a ement
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; M Professional; ❑ 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: n�
l.0 � L
Risk Manager's Signature: • Date: pill
Financial Services
This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑No[/y�. A budget amendment is necessary
before approval Yes❑NoE9 If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Bud et and Fiscal Cont r I Act:
Financial Services Director's Signature: C ��"'^�'� )L Date: �G
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 X(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has been a iew d approved by the Attorney as to legal form and sufficie cy:
Attorney's Signature Date: �6 0
County Manager
This contract has been reviewed and is approved by the Cou ty Manager Y
This contract has been reviewed and is for ture y Elerk es❑No
Manager's Signature: Date:
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