HomeMy WebLinkAboutR 2014-389 AS - Nicole Kushner, DVM to perform in-house spay/neuter surgeries 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: Nicole Kushner, DVM (Veterianarian). Party/Vendor Contact Person: Nicole Kushner. Contact Phone: 919-
5938428. Party/Vendor Address: 120 Sierra Drive. City Chapel Hill. State:NC Zip: 27514 Department: Animal Services Amount: not
to exceed $17,000 ($40/hr) and up to $800 for expenses Purpose: Perform in house spay/neuter surgeries Budget Code(s): 10215020
629010 Vendor# 59458 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ Noo Contract Type: (Check one)New r_1
Renewal Z Amendment ❑ Effective Date 7/1/2014.
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes No If submitted forbid
were bids/RFPs received Yes❑ NoZ. Bid/RFP number This contract has been reviewed and approved by the Department
Director as to technical content:
Department Director's Signature: Re e 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; E] Auto; ❑ WC; ❑ Professional; ❑ Property; ❑ OR No Insurance Required T Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as sho flE
o(Ra�ifl
Date: JUL 2014 aToT,
by the Risk Manager:
2 5
Risk Manager's Signature: 6a
q tea
Financial Services jBy_1
This Contract is conditioned pon appropriation by the Board of Commissioners YesF�Nold A budget amendment is necessary
before approval YesE]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 ct:
(I rlA-,
Financial Services Director's Signature: j e_ Date:
County Attorney
Approval by Board 0 (Contracts over $25,000.00 or any BOCC consultant contract). Approval by Manager 9 (All contracts
$25,000.00 or less with the exception of BOCC consultants). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Date:
L I
County Manager
This contract has been reviewed and is approved by the County Manager Yes[9'NoF1
This contract has been reviewed and *�to be submitted for BOCC consideration Yes[]Nor-1.
�L �bb submitted for
Manager's Signature: U Date:
Clerk to the Board
Approved by Board Yes❑No❑ Agenda Date:
Clerk's Signature: Date: