HomeMy WebLinkAbout2012-261 S Mgr Duke HomeCare & Hospice Outside Agency $1,000 )
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: Duke HomeCare&Hospice PartyNendor Contact Person: Dale Horton Contact Phone: 919-668-0727
PartyNendor Address:4321 Medical Park Drive, Suite 101 City Durham State:NC Zip:27704 Department: Outside Agencies
Amount: $1,000 Purpose: Outside Agency Budget Code(s): 10495050-710026 Vendor#50707 (N/A if new vendor) Vendor is a
BOCC consultant? Yes 0 No i4 Contract Type: (Check one)New 0 Renewal P Amendment Ej Effective Date 07/01/2012
Approved by Board Yes EI No0 Agenda Date: 06/19/2012 Title of Contract: 2012-13 Outside Agency Performance Agreement
If this is a Grant Agreement, pre-application has bee i approved by the Board of Commissioners Yesn NoE]. If submitted for bid were
bids/RFPs received YesE]NoE] Bid/RF'Inu 1,I e This contract has been reviewed and approved by the Department Director as to
technical content: 1
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' 1.III
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Department Director's Si. , . ure: ..2 Date: 7_ i _i 1--
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IT 0 rector
(Applicable only to harchvare/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; EirAuto; WC; Professional; Property; P OR No Insurance Required [1. Hold
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0 0
Contract pending receipt of Certificate of Insurance i With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: ake....._ • Date: 11 1-41 II'
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Financial Services
This Contract is conditioneon appropriation by the Board of Commissioners YesEINo . A budget amendment is necessary
before approval Yes[1 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 Bu t and Fiscal Co trol A t:
Financial Services Director's Signature: • Date: -7i7A,(if 2,-
County Attorney
Approval by Board Z (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Maria: LI (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
iI
f VII) I
1 112--
Attorney's Signature 66 16 Aalkk Date: 2.1
County Manager
This contract has been reviewed and is approved by the County Manager Yestlislop.
This contract has been reviewed and is to be submitted for BOCC consideration YesEqoEl.
Manager's Signature: AI
II / / alP Date: --7 --(-2--
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 April 2010