HomeMy WebLinkAboutR 2014-182 ES - White Cross Fire Volunteer for fire protection 144--- t ex>__
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: White Cross Fire Volunteer Party/Vendor Contact Person: Philp Nasser i Contact Phone: 919-942-1149
Party/Vendor Address: 1141 White Cross Rd 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 the Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP numbe This con ct has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date: l
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 ❑. With incorporation of Insurance provisions as sTho -]
by the Risk Manager:Risk Manager's Signature: Date:Financial Services This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[� A
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 Act:
Financial Services Director's Signature: At ��"�- Date: I
�tltt
County Attorney
Approval by Board Pi(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 h�viiiewedd proved by the Attorney as to legal form and sufficiency:
Attorney's Signature - - Date:
County Manager
This contract has been reviewed and is appr ve t unty Manager Ye o❑.
This contract has been reviewed and is ig re y e it 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