HomeMy WebLinkAboutR 2013-454 Health - InterState Outdoor for maintaining an outdoor advertising display $2,350 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: Interstate Outdoor Party/Vendor Contact Person: Contact Phone: 919-965-6646 Party/Vendor Address:
P.O.Box 124 City Selma State:NC Zip:27576 Department: Public Health Amount: 2,350 Purpose: Provider will maintain an
outdoor advertising display Budget Code(s): 1041202-680050 Vendor#62168 (N/A if new vendor) Vendor is a BOCC consultant?
Yes❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date August 5,2013 Approved by Board
Yes❑No❑ Agenda Date: Title of Contract: Business Associate 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:
t
Department Director's Signature: Date:—//4 l
i
(Applicable only to hardware/software purchases or related services)This contract has been reviewed and a roved by the Infor
Technology Director as to technical content and information tec.hra!_i _
IT Dir nature: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ 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: e J.r-� 4
Risk Manager's Signature: �i�- �sv -- Date: 1 h l, 13
Io[10
Financial Services
This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑No2+ ' A budget amendment is necessary
before approval Yes❑ No[Z. 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-
e: ,G c�. ✓ Date: l�'
Financial Services Directors Signature: _
tot
County Attorney
Approval by Board ❑ (Contracts $90,00000 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval Manager[(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has be r\ iew a approved by the Attorney as to legal form and suffic'ency.
Attorney's Signature Date-
County 3
County Manager
This contract has been reviewed and is appr ved b the County Manager Yeso❑.
This contract has been reviewed d for 'g t e by Chair es❑No❑.
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