HomeMy WebLinkAboutR 2014-456 Health - Piedmont Health Services for services of 20 hrs. per week of a NC licensed Registered Dietitian 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: Piedmont Health Services Party/Vendor Contact Person: Brian Toomey Contact Phone: 781-687-9500
Party/Vendor Address:229 Lloyd Street City Carrboro State:NC Zip:27510 Department:Public Health Amount: $30,500 Purpose:
Services to be rendered by the County to PHS with respect to: Twenty hours per week services of a North Carolina licensed Re isg tered
Dietitian Budget Code(s):N/A Vendor#27898 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:
(Check one)New❑ Renewal® Amendment ❑ Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date:
Title of Contract:Registered Dietitian Services Agreement
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 hardware/software purchases or related services)This contract has been reviewed and approved y t e Information
Technology Director as to technical content and information technolo
ec ors ignature: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Ins
Contract pending receipt of Certificate of Insurance R. With incorporation of Insurance provisions as shoe d t ' t c 's
by the Risk Manager: ''
Risk Manager's Signature: _ Date: AUG G ZOI4
81a By
Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[V/ 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 Budget and Fiscal Control Act-
Financial Services Director's Signature: //� Date: [Do/
10[j qL
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 M ger (Most other contracts$1,000 and above). Department Director approval only E] (Under
$1,000). This contract has been revi and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
_r County Manager
This contract has been reviewed and is approved by the County Manager Yes No❑.
This contract has been reviewed a s for pgnat by e Chair Yes❑No❑.
Manager's Signature: _ Date: 1C
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