HomeMy WebLinkAbout2012-215 S DSS - Personalized patient Home Assistance for in home services $415,647 o?t ia-m5
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: Personalized patient Home Assistance Party/Vendor Contact Person: Dorthea Farrington Contact Phone: 919-929-
4943 Party/Vendor Address: 109 Concord Drive City Chapel Hill State:NC Zip:27278 Department:DSS Amount: not to exceed
$415,647 Purpose: in-home services Budget Code(s): 10400220-630000 Vendor# (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑Noll Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date 07/01/12 Approved by
Board Yes No❑ Agenda Date:06/05/12 Title of Contract: In-Home Aide Provider Services 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 Date: `)S -12--
t
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 Man Bement
Ef Include the following coverages: [�CGL; E Auto; [ 'WC; []Professional; R'Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance Er With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager: �Risk Manager's Signature: �/�� �� J• Date: (11'
Financial Services
This Contract is condition upon appropriation by the Board of Commissioners YesENo A budget amendment is necessary
before approval Yes❑ No11]. If budget amendment is necessary, please attach to this form. his instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature: �W`mow A Ast---, Date: 11 411 12"
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 b Manager❑ (Most other contracts$1,000 and above). Department Director approval only ❑(Under
$1,000). This contract has bee I I i wed • roved by the Attorney as to legal form and sufficie cy:
al)
�
Attorney's Signature -r Date: i
County Manager
This contract has been reviewed and is approved by the County Manager Yes'No❑.
This contract has been reviewed and is fs '::i tur- by e / esf�l�Iq r"
Manager's Signature: - -/_/_ , rr Date:
`; ®tom e lard A roved b BOCC on the da of 20 ..b -d for Chair signature IVA
t..• day o ,20 .
PP by day , �r
Clerk's Signature: (to / /, Date: /
Revised March 2012