HomeMy WebLinkAboutR 2014-102 EMS - Efland Fire Department Fire Protection Agreement �-lob
ORANGE COUNTY-CONTRACT CONTROL SHEET
Routing Order: (1)Department, (2)IT,(3)Risk Managemen,(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: Efland Fire Department Party/Vendor Contact Person: Kevin Brooks Contact Phone:919-732-8941 Party/Vendor
Address:P.O.Box 39 City Eflan d State:NC Zip:27243 Department:Emergency Services Amount: Purpose:Fire Protection
Agreement 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 Approved by Board Yes®No❑ Agenda Date:
11/19/2013 Title of Contract:Fire Protection and Emergency Services Agreement
If this is a Grant Agreement,pre-application has been approve by the Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP nu ber T contract has been reviewed and approved by the Department Director as to
technical content: / ,/ n
Department Director's Signature: Date: l Sri aC,01cl,
IT Director
(Applicable only to hardware/softwar urchases 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; ❑ 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:
Risk Manager's Signature: Date: ?
Financial Services
This Contract is condi 'oned upon appropriation by the Board of Commissioners YesENo❑. A budget amendment is necessary
before approval YesMNo❑. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budg t and Fiscal Control Act:
Financial Services Director's Signature: Date: 117LI
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❑(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has bees re 'ewed an p 'oved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by the County Manager Yes[]No❑.
This contract has been reviewed and is for signature by the Chair Yes❑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