HomeMy WebLinkAboutR 2015-488 Health - Orange County Schools for nursing services 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: Orange County Schools Party/Vendor Contact Person: Kay Maness Contact Phone:919-732-8126 Party/Vendor
Address:200 E.King Street. City Hillsborough State:NC Zip:27278 Department:Health Amount: $239,700 Purpose:Fuinds for
school nurses Budget Code(s): 10495020-631100 Vendor# 178 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No®
Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 7/1/15 Approved by Board Yes®No❑
Agenda Date:June 16,2015 Title of Contract:Orange County Schools School Nursing Services
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:
c
Department Director's Signature: Date: ' p _/•_
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:
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 BZ; 4 and/Fiscal Control ct:
Financial Services Director's Signature: '� &M C/CO Date:
County Attorney
Approval by Board ❑ (Contracts $90,00Q__010 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manage ] (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract h s ee viewed and approved by the Attorney t legal form and sufficiency:socr,-C&rati+c�l qis
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Attorney's Signatur Date: ct
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