HomeMy WebLinkAboutR 2014-213 Planning - Pilot Environmental Inc. for Environmental Services ,�C)14- 7
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: Pilot Environmental,Inc. Party/Vendor Contact Person: BradleyLuckey Contact Phone: 336-708-4997
Party/Vendor Address:P.O.Box 128 City Kernersville State:NC Zip:27278 Department:Planning Amount: $31,650 Purpose:
Environmental Services Budget Code(s): 10620020-630000 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes
❑No® Contract Type:(Check one)New® Renewal❑ Amendment ❑ Effective Date May 15,2014 Approved by Board Yes
❑No® Agenda Date:N/A Title of Contract: Services Agreement Under$90,000
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 N/AThis contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signatu
X,
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; El Property; OR No it, d F1 H d
Contract pending receipt of Certificate of Insurance E. With incorporation of Insurance provisions as s1 1' cKat#ta a�p d
by the Risk Manager:
g g (� Date: 5 j ' MAY — 5 2014
Risk Manager's s Si nature:
s1S
Financial Services By
This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No®. 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 Co n rol Act:
Financial Services Director's Signature: l `" —5141 51� 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 r iewed ved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: S ��
County Manager
This contract has been reviewed and is appro by the County Manager Yes ,
This contract has been reviewed and is or s' t by th C a' es ®.
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