HomeMy WebLinkAboutR 2013-287 Aging - Personalized Patient Home Assistance for In home Services $415,647 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: Personlized Patient Home Assistance Party/Vendor Contact Person: Dorthea Farrineton Contact P
929-4943 Party/Vendor Address: 109 Concord Drive City Chapel Hill State:NC Zip: 27516 Department: DSS A unt: $415,647--�
Purpose: In home services Budget Code(s): 10400220630000 Vendor# 17354 (N/A if new vendor) Vendor is BOCC nt?
Yes❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 07/01/13 Approved by Board Yes
®No❑ Agenda Date: 05/07/13 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 Signature: Date: 7
1 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:
isk Management
Include the following coverages: VCGL; [Auto; 56 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:
614
Risk Manager's Signature: �l n�"V� 12 13
^�'� �' Date: J
. -t[z�[13
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes[ budget amendment is necessary
before approval Yes❑ No�lf 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 Contr Act:
Financial Services Director's Signature:
N-14.9/ Date: / 74 I
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 by Manager% (Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). Tcontract has bee viewed and approved by the Attorney as to legal form and suffi iency:
Attorney's Signature Dater
County Manager
This contract has been reviewed and is approved by the County Manager Ye No❑.
This contract has been reviewed and is for signature the Chair Yes❑NoQ./
Manager's Signature: Date:
�r 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:
RHviSed M arch 2012