HomeMy WebLinkAboutR 2013-394 Health - UNC School of Dentistry $55,848 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: Unc School of Dentistry Party/Vendor Contact Person: Martha B.Barbour Contact Phone: 919-537-3570
Party/Vendor Address:467 Brauer Hall City Chapel Hill State:NC Zip: 27599 Department:Public Health Amount:$55,848 Purpose:
Provider will provide one or more postgraduate year one or two level in the Dental Health Services Divsions to provide ambulatory dental
services for the academic year 2013-2014 Budget Code(s): 10410420-630000 Vendor#36302 (N/A if new vendor) Vendor is a
BOCC consultant? Yes❑No® Contract Type: (Check one)New®Renewal ❑ Amendment ❑ Effective Date July 1,2013
Approved by Board YesD No❑ Agenda Date: Title of Contract: Graduate Resident Services
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 Signatu C.Mb Date: Q— -13
IT Director
(Applicable only to hardware/software 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:
��-+e►^s R k Mana mentL �
Include the following coverages: [Vf -CGL; [V Auto; C; Professional; ❑ Property; OR No Insurance Required R. Hold
Contract pending receipt of Certificate of Insurance anc� With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date: Z
Z4-c-- , `°'I h
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[!/ A budget amendment is necessary
before approval Yes❑No[HIf 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: .'t u _� /)4 --- Date: V v J.3
lalza
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 Manager other contracts$1,000 and above). Department Director approval only E] (Under
$1,000). This contract has be +ew d approved by the Attorney as to legal form and sufficient :
1! ,
Attorney's Signature Date: I 3 IS
County Manager
This contract has been reviewed and is r v y the ounty Manager Yes❑No❑.
This contract has been reviewed s fo i a re e it s❑No❑.
v
Manager's Signature: Date: 111112�,/ZV
Clerk to the Board
Approved by BOCC on the_day of 120 Submitted for Chair signature on the_day of ,20
Clerk's Signature: Date:
Revi.sed March 2012