HomeMy WebLinkAboutR 2013-430 EMS - Orange Grove Fire Company for Emergency Medical Services Substation $6,000 ,z,
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 re iew should
be completed through the legal review process prior to being routed for signature.
Department
Party/Vendor Name: Orange Grove Fire Company Party/Vendor Contact Person: Chief Steve McCauley Contact Phone: 3 6-263-2823
Party/Vendor Address:6800 Orange Grove Road City Hillsborough State:NC Zip: 27278 Department: Amount:
Purpose:EMS co-location Budget Code(s): Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No
® Contract Type:(Check one)New® Renewal ❑ Amendment ❑ Effective Date September 17,2013 Approved by Board Yes
®No❑ Agenda Date: September 5,2013 Title of Contract: Use agreement for emergency medical services substation
If this is a Grant Agreement,pre-application has been approved by the Boa d of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP ber This contract been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date: t o 3
IT Director
(Applicable only to hardware/softwa e purchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to technical content and information technology specifications:
IT Director's Signature: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; Vq.P operty, OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance ❑. With inco oration of Insuranc rovisions as shown,this contract is approved
by the Risk Manager: C,e �
Risk Manager's Signature: Date: ?
& 9
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑NoE� A budget amendment is necessary
before approval Yes❑No I If 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: Date: l o�5 13
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 Manager 4(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has been r 'ewe an pproved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County ManaLer
This contract has been reviewed and is a ro d by the County M nager Yes[ No❑.
This contract has been reviewe is o g tur th air es❑No❑.
ci
Manager's Signature: Date:
Clerk to 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