HomeMy WebLinkAboutR 2015-150 Health - CHCCS - Agreement for School Nursing Services for July 1, 2014 - June 30, 2015
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❑No® Contract Type: (Check one)
New❑ Renewal ® Amendment ❑ Effective Date July 1,2014 Approved by Board Yes❑No❑ Agenda Date:July 1,2014-
June 30,2015 Title of Contract:A_greement 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: 5--
(ApplicabTe on re/software pur=ni��chn�olos�pecific�ations: been reviewed and approved by the Information
Technology Director as to technical conten
JT-Direetar'_sk_M
Risk Manage ment
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of insurance provisions as sho thrs-contmctj
by the Risk Manager: l
Risk Manager's Signature: _ Date: 3 lid / N14 10 2015
Financial Services
This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No❑. A bu B
before approval Yes❑Nor-1. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government"get and Fiscal o trol Act:
Financial Services Director's Si nat r •�� �-�✓'le'2��'1 J9� • 3 1 d e-
1; u e. �r Date. l
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 b Manager (Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has bee MM!:oved by the Attorney as to legal form and sufficiency: �rC n�
Attorney's Signature Date: sl{1 11is-
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