HomeMy WebLinkAboutR 2013-449 Health - Starpoint Global Service for Imaging Patient Records and Other Services $33,350 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: Starpoint global Service Party/Vendor Contact Person: Richard Ray Contact Phone:919-933-9529 Party/Vendor
Address: 1 Ashley Wade Lane City Chapel Hill State:NC Zip:27516 Department:Public Health Amount: $33,350 Purpose:Imag_in
Patient Records and Other Servicesas provided in Estimated Cost and Service Proposal Budget Code(s):61-3700-35-800100-30012
Vendor#690039 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal
❑ Amendment ❑ Effective Date October 21,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract:
Business Associate 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: le-4
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; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance ❑. Wit®h iinco_rporation of Insurance provisions as shown,this contract is approved
by the Risk Manager: e
Risk Manager's Signature: l�C� /`- -�`'�- Date: /.6 Z�
Financial Services
This Contract is conditioned Aon appropriation by the Board of Commissioners Yes❑ .No A budget amendment is necessary
before approval Yes[]NoIf 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:r 1
Financial Services Director's Signature: '-w �� Date:
10 1 Z8
County Attorney
Approval by Board ❑ (Contracts $90,00010J or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Manager (Most other contracts 51,000 and above). Department Director approval only❑(Under
$1,000). This contract has be i d d approved by the Attorney as to legal form and suffici ncy:
Attorney's Signature Date: 1 1 I
County Manager
This contract has been reviewed and is a P ro by the County Manager Yes lo❑.
This contract has been reviewe is r s' atur the it Y No❑.
c.i
Manager's Signature: Date:
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