HomeMy WebLinkAboutR 2010-114 Aging - UNC Hospitals wellness program coordinator il�
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: UNC Hospitals Party/Vendor Contact Person: Susan Blalock Contact Phone: 966-3887 Party/Vendor Address:
20610 Neurosciences Hospital, 101 Manning Drive City Chapel Hill State:NC Zip:27514 Department:Aging Amount: $25,000
Purpose:Wellness Program Coordinator Budget Code(s): 29430305-499999 Vendor#30892 (N/A if new vendor) Vendor is a BOCC
consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/10 Approved by
Board Yes®No❑ Agenda Date: included in FYI budget Title of Contract: UNCH#649
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: f I f_n
IT Director
(Applicable only to hardware/sofhvare 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; [l 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: ' Z 3 •��
Rat'd if/o/to
Financial Services
This Contract is conditione pon appropriation by the Board of Commissioners Yes❑No A budget amendment is necessary
before approval Yes❑ No[N. If budget amendment is necessary,please attach to this form. T is instrument has been pre-audited in the
manner required by the Local Government Bud et and Fiscal Control Act:
ly
Financial Services Director's Signature: �� Date:
County Attorney
Approval by Board 4 (Contract over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Manager (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Date: a Gb
County Man�er �
This contract has been reviewed and is approved by the County Manager o❑.
T his contract has been reviewed and is to be submitted for B C consideration Yes❑N�0 -
Manager's Signature: Date: l
U
Jerk to the Board
Approved by BOCC on the dvTqf 5201 Submitted for Chair signature on the day of ,20
Clerk's Signature: Date:
,/kz cQ aka1 0
Revised April 2010