HomeMy WebLinkAboutR 2014-386 Health - Robert E. Dupuis for Direct Pharmacy Services at the two pharmacy sites of Health Dept r
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: Robert E.Dupuis Party/Vendor Contact Person: Robert E.Dupuis Contact Phone: 919-966-6194 Party/Vendor
Address: 205 Kenilworth Place City Chapel Hill State:NC Zip:27516 Department:Public Health Amount: $12,397 Purpose: Direct
Pharmacy Services at the two pharmacy sites of the Health Department Budget Code(s): 10414020-630000 Vendor#47361 (N/A if
new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New N Renewal Amendment ❑
Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Pharmacy Services 2014-2015
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 Director's Signature: Date: 3-
(Applicable only to hardware ases or related services)This contract has been reviewed and approv(;d by the Information
Technology Director as to technical content and information ec ions:
Risk Management
Include the following coverages: [g,*CGL; ❑ Auto; ❑ WC; 0-11i•ofessional; ❑ Property; OR No Ins au- f—l. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as show [�Kc#a�i flaToT
by the Risk Manager: JJ
Risk Manager's Signature: _ Date: (, JUL 2-1 2014
Financial Services B',
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[q/ 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 Bud gel and Fiscal Con 1 Act:
Financial Services Director's Signature: M4,l,✓ /0'
Date:
111ZE
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 3,k Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has bee r iew approved by the Attorney as to legal form and suffici ncy
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by the County Manager YesRf,4oEl
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
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