HomeMy WebLinkAboutR 2013-518 EMS - New Hope Fire Department For Fire Protection Agereement ,�OIB - 51a
RANGE 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: New Hope Fire Department Party/Vendor Contact Person: Michael Tapp Contact Phone: 919-619-8685
Party/Vendor Address:4012 Whitfield Road City Chapel Hill State:NC Zip:27516 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 approved by t Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP n e This co ct has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date:
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:Q �,. Date: /
1JlollZ
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[Rf 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: /J
Financial Services Director's Signature: ��fkG,L �� Date: -f
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County Attorney
Approval by Board)?!r(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 vie we a proved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: °I
County Manager
This contract has been reviewed an is p v by the County Manager Yes2NoEl.
This contract has been reviewe d i or si ature th Phair Yes❑No❑.
Manager's Signature: Date:
k to the a
Approved by BOCC on the day of 12 i r hair signature on fhe f y of 120
Clerk's Signature: Date: 7 2 u
Revised March 2012