HomeMy WebLinkAboutR 2014-206 Health - NC Dept. of Health and Human Services Division of Public Health - FY 2015 Consolidated Agreement 11?61_q_ .000 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: OCHD Party/Vendor Contact Person: Pascal Moore Contact Phone: 919-245-2460 Party/Vendor Address: 300
W.Tryon Street City Hillsboroueh State:NC Zip:27278 Department:Public Health Amount:N/A Purpose:= Budget Code(s):N/A
Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New® Renewal❑
Amendment ❑ Effective Date March 1,2014 Approved by Board Yes[]No❑ Agenda Date: Title of Contract:
Consolidated 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 contract has been reviewed and approved by the Department Director as to
technical content:
Department 's Signature: Date:
IT Director
(Applicable only to hardware/software ases or re a vices)This contract has been reviewed and approved by the Information
Technology Director as to tec content and information technolog cations:
IT Director s ignature: Date:
Risk Management
Include the following coverages: Auto; ❑ WC; ❑ Prof al; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insuran Wit rporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signat Date:
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No A budge endment is necessary
before approval Yes❑Nol V. 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: � "t"� �� f�"'- Date: Of
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or y BOCC
consultant contract). Approval by Manager❑ (Most other contracts$1,000 and above). Department Director approval only I(Under
$1,000). This contract has be n eview and approved by the Attorney as to legal form and sufficienc
Attorney's Signature Date:
�-
Cou a er
This contract has been reviewed and is approv my Manager Yes❑No❑.
This contract has been reviewed and is for si re by the C�ai No[-].
Manager's Signature: a
he
Approved by BOCC on the_day of ,20 u mitte signature on the_day of ,20
Clerk's Signature: Date:
Revised March 2012