HomeMy WebLinkAboutR 2014-459 Health - James Wise to assist OCHD to implement the CH High School Tobacco. Reality. Unfiltered. (TRU) Group 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: James Wise Party/Vendor Contact Person: James Wise Contact Phone: 919-380-1042 Party/Vendor Address:
2324 Woodbury Drive City Hillsborough State:NC Zip:27278 Department: Public Health Amount: $500.00 Purpose: Provider will
assist OCHD to implement the Chapel Hill High School Tobacco.REality.Unfiltered.(TRU) Budget Code(s): 10412020-630000
Vendor#603260 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type:(Check one)New ❑ Renewal
® Amendment ❑ Effective Date September 1,2014 Approved by Board Yes❑No❑ Agenda Date: September 1,2014-July
31,2015 Title of Contract: TRU Club Advisor JW
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:
IT rector
(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; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required j Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: 7AU Risk Manager's Signature: � O� Date:8121 2014
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No❑�. A budg amendment is necessary
before approval Yes❑No If budget amendment is necessary,please attach to this form. This instrument Ely 1 wa. pre. 911144ed in t!
manner required by the Local Government Bud a aand®®Fiscal Contro Act:
Financial Services Director's Si nature: ""`v'"L l �� Zz _ Date:
g
County Attorney
Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or an BOCC
consultant contract). Approval by Manager El (Most other contracts$1,000 and above). Department Director approval only r'(Under
$1,000). This contract has been review d 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 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