HomeMy WebLinkAboutR 2013-289 Health - Chapel Hill Carrboro City Schools Providing School nursing Services the the students $451,651 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: Chapel Hill Carboro City Schools Party/Vendor Contact Person: Tom Forcella Contact Phone: 919-967-8211
ext28 /Vendor Address: 750 S.Merrit Mill Road City Chapel Hill State:NC Zip: 27516 Department: Public Health Amount:
$ 1 651 ose: Providing school nursing services to the students in the Chapel Hill Carrboro city school system Budget Code(s):
1041 40211--630000 Vendor#616309 (N/A if new vendor) Vendor is a BOCC consultant? Xj ®No❑ Contract Type: (Check one)
ew ® Renewal Amendment ❑ Effective Date July 1,2013 Approved by Board YesN No❑ Agenda Date:
Title of Contract:Nursing Services between OCHD and Chapel Hill Carrborro City Schools
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: Date: - I
( pp o hardware/software purchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to tec nica co olo y specifications:
IT Director s I
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required Hold
Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: j �• Vr'"' Date:
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[V. A budget amendment is necessary
before approval Yes❑ Novlf 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: XAL, 4� At Date:
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 Ma ger❑ (Most other contracts $I,GOO and above). Department Director approval"only ❑ (URder
This c ntract has been revie and aplr proved yth Atto ne as f nd sufficiency: � r��{
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by the County Manager Yes No❑.
This contract has been reviewed and is for sign y t Les Manager's Signature: Date:d Approved by BOCC on the day of 20 . or Chair signature on the_day of 20
Clerk's Signature: Date:
Revised March 2012