HomeMy WebLinkAbout2012-284 -S EMS - Physio Control for Technical Service Support $32,718 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: Physio Control Party/Vendor Contact Person: Lane Rushing Contact Phone: 18004421142 Party/Vendor
Address: 11811 Willows Rd.NE City Redmon State: Washington Zip:98052 Department: Emergency Services Amount: $32,718
Purpose: Service Contract Budget Code(s): 1075752057 1000 Vendor 9 45414 (N/A if new vendor) Vendor is a BOCC consultant?
YeSE]NoE Contract Type: (Check one)New❑ Renewal Z Amendment ❑ Effective Date July 1,2012 Approved by Board
Yes❑No[g Agenda Date: Title of Contract:Technical Service Support 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❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: A c6Z 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; E] Auto; ❑ WC; E] Professional; ❑ Property; OR No Insurance Required E� Hold
Contract pending receipt of Certificate of Insurance E]. 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❑Noy 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:qw� I � 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). �by Manager (Most other contracts$1,000 and above). Department Director approval only El (Under
y
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$1,000). This contract __ revi a approved by the Attorney as to legal form and suffic�*ency.
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by the County Manager Yes2lNo❑.
This contract has been reviewed and is for signature by the Chair Yes❑NoEJ'
Manager's Signature: Date:
erk to the Board
'W�
S mit or
Approved by BOCC on the—day of 2 Submitted for Chair signature on the v day of 120 .
Clerk's Signature: Date:
Revised March 2012