HomeMy WebLinkAboutR 2015-672 Planning - NC 811 Membership Agmt routing form amendment,Revised March 2012
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: North Carolina 811, Inc. Party/Vendor Contact Person: Lesley Brouillard Contact Phone: 336-855-5760
Party/Vendor Address: 2300 West Meadowview Rd, Ste 227 City Greensboro State: NC Zip: 27407 Department: Planning Amount:
$100 Purpose: Membership in underground utility notification clearinghouse Budget Code(s): 51360120-807000 Vendor # New (N/A
if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment
Effective Date 11/1/2015 Approved by Board Yes No Agenda Date: Title of Contract: North Carolina 811, Inc.
Membership 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: _____________
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: _____________
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 Budget and Fiscal Control Act:
Financial Services Director’s Signature: _____________________________________________ Date: ______________
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 Manager (Most other contracts $1,000 and above). Department Director approval only (Under
$1,000). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency:
Attorney’s Signature ___________________________________________________ Date: _____________
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:______________
DocuSign Envelope ID: D366C46C-DA8A-4CDF-A1E7-7A506E4671A2