HomeMy WebLinkAboutR 2014-250 ES - Orange Rural Fire Department for Use Agreement of EMS Substation �014_Zc0
ORANGE COUNTY—CONTRACT CONTROL SHEET
Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager, ( i ( Ierk
This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. I I the Manager
determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval r otitracts for
BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for lega I r i C w should
be completed through the legal review process prior to being routed for signature.
Department
Party/Vendor Name: Orange Rural Fire Department Party/Vendor Contact Person: Matt Heinze Contact Phone: 1'im,k Vendor
Address: 835 Phelps Road City Hillsborough State:NC Zip:27278 Department: Orange County Emergency Services An emit: 0.00
Purpose: Use agreement of substation Budget Code(s): Vendor#50210
(N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New❑ Renewal❑ \mC ndment
❑ Effective Date Approved by Board Yes❑Nor-1 Agenda Date: Title of Contract:
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted loo bid were
bids/RFPs received Yes❑No[:] Bid/RFP number This c act has been reviewed and approved by the Department I)irector as to
technical content:
Department Director's Signature: Date:/ /
IT Director
(Applicable only to hardware/software p rchases or related services)This contract has been reviewed and approved by tht I n forination
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 sho i gthiract i";' ''J
by the Risk Manager: t J
Risk Manager's Signature: L omp ,Les Date: MAY 314
Financial Services By
This Contract is conditioned" on appropriation by the Board of Commissioners Yes❑No[( A budget amen nii iifi i "n
before approval Yes❑NoMIf budget amendment is necessary,please attach to this form. This instrument has been prc-audited in the
manner required by the Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature: � Date:
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, of .iny BOCC
consultant contract). Approval by Manager (Most other contracts$1,000 and above). Department Director approval on l, ❑ (Under
$1,000). This contract has bee iew approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: ► �"
County Manager
This contract has been reviewed and is approved by the County Manager Yes[ No❑.
This contract has been reviewed and is for si ure b the 9air Yes❑No❑.
Manager's Signature: 'y '� if Date:
1
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