HomeMy WebLinkAboutR 2014-414 Health - Chapel Hill Carrboro City Schools to provide school nursing services to the students P4- 4)4
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: Chapel Hill Carboro City Schools Party/Vendor Contact Person: Rudy Pittman Contact Phone: 919-967-8211
ext;28226 Party/Vendor Address: 750 S. Merrit Mill Road City Chapel Hill State:NC Zip:27516 Department:Public Health Amount:
$460,684 Purpose: Providing school nursing services to the students in the Chapel Hill Carrboro city school system Budget Code(s):
10495020-631100 Vendor#22226 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑NoZ Contract Type: (Check one)
New❑ Renewal Z Amendment F-1 Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date:
Title of Contract: Agreement For School Nursing Services Between The County Of Orange And The Chapel Hill Carrborro City Schools
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:
(Applicable only to hardwarelsoftware purchases or related services)This contract has been reviewed and approve y n
Technology Director as to technical content and information technology specifications:
Risk Management
Include the following coverages: ❑ CGL; F-1 Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required Hold
Contract pending receipt of Certificate of Insurance n. With incorporation of Insurance provisions as sho scontract is 2roved
by the Risk Manager: n rn)
Risk Manager's Signature: Date: AUG 2014
SIG
Financial Services
This Contract is conditioned upon appropriation by the Board of Commissioners YesE]No&�' A 42 amendment is necessary
before approval Yes❑Noa. If budget amendment is necessary,please attach to this form. This instrument has been_p_re_--a—ua—Md-ft7ftW
manner required by the Local Government Budget and Fiscal q4?ntrol Act:
'y 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, 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 revi d d roved 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 E�'/NoEJ.
This contract has been reviewed and is f natur y the Chair Yes❑No❑.
Manager's Signature: Date:
t
Clerk to the oard
Approved by BOCC on the_day of 20 Submitted for Chair signature on the—day of 20
Clerk's Signature: Date:
Revised March 2012