HomeMy WebLinkAboutR 2013-465 EMS - Physio Control Inc for Difibrillator Service and Maintenance $10,875 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. INC. Party/Vendor Contact Person: Lane Rushing Contact Phone: 18004421142(ext
72368) Party/Vendor Address: 11811 Willows Rd.NE PO BOX 97006 City Redmond State: WA Zip: 98052 Department:Emergency
Services Amount: $10875.00 Purpose:Defibrillator Service and Maitenance Budget Code(s): 10757520-571000 Vendor#45414
(N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New❑ Renewal® Amendment
❑ Effective Date July 1,2013 Approved by Board Yes❑No® Agenda Date: Title of Contract:Physio-Control Technical
Service Support Agreement A60-3185
If this is a Grant Agreement,pre-application has been approv by the Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP number contract has been reviewed and approved by the Department Director as to
technical content: /
Department Director's Signature: 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; ❑ Auto; ❑ 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:
Risk Manager's Signature: 40-- Date: ( 13
Financial Services
This Contract is conditioned (on appropriation by the Board of Commissioners Yes❑NoU0111, A budget amendment is necessary
before approval Yes❑Nol V1. 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 /nndF.isc-al Control)Act: d
Financial Services Director's Signature: "'"^--� A /1941� 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). Approva y Manager X (Most other contracts$1,000 and above). Department Director approval only❑ (Under LZI
$1,000). This contract has bee view approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: 1
County Manager
This contract has been reviewed and is ap ve by the County Manager Yes[ No❑.
This contract has been reviewed is f i a re b h h Yes No❑.
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