HomeMy WebLinkAbout2012-196 S DSS-Senior care of Orange county Inc $20,000 21.D1=.?-19,C
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
PartyNendor Name: Senior Care of Orange County, Inc PartyNendor Contact Person: Alvonia Baldwin Contact Phone: 919-245-2017
Party/Vendor Address: PO Box 8181 City Hillsborough State: NC Zip:27278 Department: DSS Amount: not to exceed$20,000
Purpose: Adult Day Health Services Budget Code(s): 10400220-630000 Vendor# (N/A if new vendor) Vendor is a BOCC
consultant? Yes❑Nor] Contract Type: (Check one)New❑ Renewal ® Amendment El Effective Date 07/01/12 Approved by
Board Yes❑No❑ Agenda Date: 06/15/12 Title of Contract: Senior Care of Orange County,Inc
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: /, : _ - /�A Date: 014-o1-{"1y
IT Director
(Applicable only to hardware/software purchases o relate services)This contract has been reviewed and approved by the Information
Technology Director as to technical content and info ion technology specifications:
IT Director's Signature: Date:
ask Ma Bement
Include the following coverages: [ CGL; E f Auto; WC; Professional; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance 5 With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: 44...c... / Date: 71/112
Financial Services
This Contract is conditioned on 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 Ac
Financial Services Director's Signature: a"4,-4,—.
/�' • .(/"- Date: 7(2114-
g
[Pi Z5;11 i County Attorney
Approval by Board ❑ (Contracts $90,000.0 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approva by Manager (Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has be eviewed d a proved by the Attorney as to legal form and suffici cy:
Attorney's Signature Date: I --
County Manager
This contract has been reviewed and is approved by the County Manager YeseNo❑.
This contract has been reviewed and is for sig :ie b the ha' Yes❑No[�.
Manager's Signature: I I / / Date: 7 et—/
lerk 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