HomeMy WebLinkAboutR 2014-222 ES - NC Dept of Public Safety Division of EMS for MOA-Orange County CERT lam-ZzZ.
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: NC Dept of Public Safety Division of EM Party/Vendor Contact Person: Dianne Benton Contact Phone: 919-825-
2257 Party/Vendor Address: 1636 Gold Start Drive City Ralei h State:NC Zip:27607 Department: Oranjze County Emergency
Services Amount: Purpose:MOA-Orange County CERT 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: Title of Contract:
If this is a Grant Agreement,pre-application has b approved the Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP be r Thi c tract has been reviewed and approved by the Department Director as to
technical content: �7
Department Director's Signature• Date: /
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 sh
by the Risk Manager: D lJ 0
Risk Manager's Signature: Yl Date: MAY " 7 2014
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑ .No A b
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: ej
Financial Services Director's Signature: C �� ,� Date: 7 I
5l7
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). Approva y Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has b n eview approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is appro ed b the County Manager Yes No[:].
This contract has been reviewed an r s' nat by t air s❑
v �Manager's Signature: Date: A
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