HomeMy WebLinkAboutR 2014-263 ES - Town of Carrboro Fire-Rescue Department for Use Agreement for EMS substation 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: Town of Carrboro Fire-Rescue Department Party/Vendor Contact Person: Chief Travis Crabtree Contact Phone:
(919)918-7348 Party/Vendor Address: 301 W.Main Street and 1411 Homestead Road City Carrboro State:NC Zip:27510
Department: Orange County Emergency Services Amount: 0.00 Purpose: 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 been approve the Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP b T ' ntract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date:
IT Director
(Applicable only to hardware/software rchases 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 Q
Risk Manager's Signature: a �J.O Date: MAY 3 O 20I4
Sly
Financial Services
This Contract is conditioned u n appropriation by the Board of Commissioners Yes❑No[g/ A b
before approval Yes❑No�f 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: r//
Financial Services Director's Signature: �C 1J� / Date: t/6
1,1z.
County Attorney
Approval by Board ❑ (Contracts $90,000 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval Manager[(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has J'aree, ie w approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: U'st 4
County Manager
This contract has been reviewed and is appr d e County Manager Yes No❑.
This contract has been revieweN
Manager's Signature: Date:
Clerk to the Board
Approved by BOCC on the day of 120 Submitted for Chair signature on the_day of ,20
Clerk's Signature: Date:
Revised March 2012