HomeMy WebLinkAboutR 2013-172 Health - Health Metrics for Identification and documentation of the best demostrated practice for family planning $25,000 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
Party/Vendor Name: HealthMetrics Party/Vendor Contact Person: Charles L. Moore Contact Phone: 781-687-9500 Party/Vendor
Address: 329 Massachusetts Ave Suite 4 City Lexington State: MA Zip: 02420 Department: Public Health Amount: $25,000 Purpose:
Identification and documentation of the best demonstrated practice for fam EIannine Budget Code(s): 10414020-630000 Vendor#
N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal❑
Amendment ❑ Effective Date June 20,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Optimal
Performance
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:
i
Department Director's Signature: Date:
IT Director
(Ap—piisakle only to hardware/software purchases or related services)This contract has been reviewed and approved b
Technology Direc o nt and information technolo v s
IT Director' Date:
isk Ma ale ment
Include the following coverages: N(CGL; [dAuto; F4 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: r/
Risk Manager's Signature: Off.. Date:
Financial Services
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[/ A budget amendment is necessary
before approval Yes❑Now 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: A AA4A, Date: s '1.3
County Attorney
Approval by Board E] (Contracts $90,00 .0 or more for roods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approv y a r IKI (Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has be n vi d d pproved by the Attorney as to legal form and suffici cy:
Attorney's Signature Date: (7
County Manager
This contract has been reviewed and is approved by the FCn1hyir t Manager Yes o
This contract has been reviewed and is f sin Yes❑No
Manager's Signature: Date:6/0 r/6/ Y.
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 March 2012