HomeMy WebLinkAboutR 2013-533 EMS - Orange Grove Fire Department for Fire Protection Agreement _;1o)3- C),.� 2ANGE 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: Orange Grove Fire Department Party/Vendor Contact Person: Steve McCauley Contact Phone: 919-967-5858
Party/Vendor Address: 6800 Orange Grove Road City Hillsborough State:NC Zip:27278 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®Nor-1 Agenda Date: 11/19/2013 Title of Contract:Fire Protection and Emergency Services 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 ntract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date: /yo
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:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date: /
X31
Financial Services
This Contract is condit ned upon appropriation by the Board of Commissioners Yes[VNo❑. 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 Budget and Fiscal Control Acct:
Financial Services Director's Signature: (";ow JJ` �G/�"'�" —' Date:
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 been re iewed pproved by the Attorney as to legal form and sufficiency:
Attorney's Signature Dater
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