HomeMy WebLinkAboutR 2013-265 Health - Piedmont Health Services for Services to be rendered by the County to PHS with respet to 245 hr per wk of NC licensed rigistered dietitian aoi3^ ab�
ORANGE COUN T. -CONTRACT CONTROL SHEET
Routing Order: (1) Department,(2)IT,(3) Risl< Nlaliauement. (4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk
This Document shall accompany all contracts and shay 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: Piedmont Health Services Party/Vendor Contact Person: Brian Toomey Contact Phone: 781-687-9500
Party/Vendor Address: 229 Lloyd Street City Carrboro State:NC Zip: 27510 Department: Public Health Amount:N/A Purpose:
Services to be rendered by the County to PHS with respect to: Twenty hours per week services of a NC licensed registered dietitian
Budget Code(s): 10414020-630000 `Vr ).DS'CjE if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:
(Check one)New ® Renewal ❑ Amendment U Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date:
Title of Contract: Registered Dietitian Services Agreement
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: __ 71irlctor Date:If
(Applicable only to hardware/software purchases or relaied s-;rvices)This contract has been reviewed and approved by the Information
Technology Director as to technical content and information technoiogy specifications:
IT Director's Signature: Date:
Risk Manazement
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required VHold
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: – �• Date: � w Il-3
g
Financial Services
This Contract is conditioneVuon appropriation by the Board of Commissioners Yes❑No[� A budget amendment is necessary
before approval Yes❑No budget amendment is necssan, please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Control (t! ??
Financial Services Director's Signature: C/ A—" Date: l �J
County Attorney
Approval by Board ❑ (Contracts $90,000. 0 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 en evi ed and approved by the Attorney as to legal form and suffic'ency,
Attorney's Signature Date: '2,37,6
County Manager
This contract has been reviewed and is approved by the Coun anager Ye o
This contract has been reviewed and is for s' r th Cr , Yes❑No
i
Manager's Signature:
Date:
erk to the Board
Approved by BOCC on the_day of f'^,2i1 Snbrnitted for Chair signature on the_day of ,20
Clerk's Signature: Date:
Revised March 2012