HomeMy WebLinkAboutR 2013-431 EMS- North Chatham Fire Department for Fire Protectionn $N/A C "-2 Q��?j'd 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: North Chatham Fire Department Party/Vendor Contact Person: Chief John Strowd Contact Phone: 919-542-3380
Party/Vendor Address:45 Morris Rd City Pittsboro State:NC Zip:27312 Department: Amount: Purpose:Fire
Protection 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 July 8,2013 Approved by Board Yes®No❑ Agenda
Date:June 18,2013 Title of Contract: Fire Protection and Emergency Services Agreement
If this is a Grant Agreement,pre-application has been approved by the Boaj6 of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No[–] Bid/RFP er This contract been reviewed and approved by the Department Director as to
technical content: /
Department Director's Signature: Date: `
IT Director
(Applicable only to hardware/software urchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to technical content and information technology specifications:
Y` IT Director's Signature: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of I surance With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date:
toH
Financial Services
This Contract is condit' ned upon appropriation by the Board of Commissioners Yes No❑. A budget amendment is necessary
before approval Yes No❑. If 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 nd Fiscal Control A l
Financial Services Director's Signature: L'� Date:
LZA b
County Attorney
Approval by Boa (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❑ (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has bee rev' wed and approved by the Attorney as to legal form and sufficiency:
+
Attorney's Signature Date: �2_
County Manager
This contract has been reviewed and is a ov y the Coun M 6pger Yes10❑.
This contract has been reviewed is si a re he air s❑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