HomeMy WebLinkAboutR 2015-235 ES - Town of Chapel Hill Police Department - MOA for Naloxone program 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: Town of Chapel Hill Police Department Party/Vendor Contact Person: Tiffany. Snee Contact Phone: 919-968-
2760 Party/Vendor Address: 828 Martin Luther King Jr Blvd City Chapel Hill State:NC Zip:27514 Department:Orange County
Emergency Services Amount: Purpose:MOA Naloxone Program Budget Code(s): Vendor#64 (N/A if new vendor)
Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check one)New❑ Renewal❑ Amendment ❑ Effective Date
Approved by Board Yes❑No❑ Agenda Date: Title of Contract:
If this is a Grant Agreement,pre-application has been approved by th oard of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP numb r This co ct has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: 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; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown,this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date: / s-
Financial Services
This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No❑. 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 Bu et nd Fiscal Control Act:
Financial Services Director's Signature: 6?1yT;;z) '-1-AP1Wg1M GFb Date:
Countv 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 Manager❑ (Most other contracts$1,000 and above). Department Director approval only,V(Under
$1,000). This contract has be r ewed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: �s
County Manager
This contract has been reviewed and is approved by the County Manager Yes to❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
Manager's Signature: Date: y
Clerk to the Board
Approved by BOCC on the_day of 120 Submitted for Chair signature on the day of ,20
Clerk's Signature: Date:
Revised March 2012