HomeMy WebLinkAboutR 2013-424 Health - Jan E Jackson Provider will enforce Food Lodging and Institutional Sanitation Laws and rules $6,000 V�-
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 iManager 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: Jan E.Jackson Party/Vendor Contact Person: Jan E.Jackson Contact Phone: Party/Vendor Address: 129
Azalea Ave City Roxboro State:NC Zip:27573 Department: Public Health Amount: $6,000 Purpose:Provider will enforce Food.
Lodging and Institutional Sanitation laws and rules Budget Code(s): 10413020-630000 Vendor#N/A (N/A if new vendor) Vendor is
a BOCC consultant? Yes❑No® Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective Date August 6,2013
Approved by Board Yes❑No❑ Agenda Date: Title of Contract: REHS Service Contract
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:
C �
Department Director's Signature: Date: -
(App r l to hardware/so are purchases or relates/se rO e;)This contract has been reviewed and approved by the Information
Technology Director as content and information recl:nology specifications:
it e: _
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required 47. Hold
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:
Financial Services
This Contract is conditioned Vpon appropriation by the Board of Commissioners Yes❑Now A budget amendment is necessary
before approval Yes❑Nolf 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 Control Act,
�m� lJ q 3
Financial Services Director's Signature: _ � Date:
CountlAtlornev
Approval by Board ❑ (Contracts $90,00 004 more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Appr 1 by anager ost other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has ee re a and proved by the Attorney as to legal form and suffi(c�iency:
Attorney's Signature Date: ` 3
i
County Manager
This contract has been reviewed and is approved th ounty Manager es❑N [I.This contract has been reviewed and i sign e e a. Yes o❑.
Manager's Signature: Date: b
Clerk to the Board
Approved by BOCC on the^day of Submitted for Chair signature on the �day of -20
Clerk's Signature: _Date:
Revised March 2012
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