HomeMy WebLinkAboutR 2013-480 Health - Patterson Dental to provide upgrade existing software and other 3Services $12,000 o�l_-3- -q S()
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: Patterson Dental Party/Vendor Contact Person: Jim Hove Contact Phone: 919.614.5818 Party/Vendor Address:
6520 Meridian Dr# 132 City Raleigh State:NC Zip:27616 Department: Public Health Amount: $12,000 Purpose: Provider will
upgrade existing software and other eServices described by Patterson Dental Budget Code(s): 61370035-800100-30012 Vendor#24726
(N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal ❑ Amendment
❑ Effective Date November 1,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: Patterson eServices
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: INW-13
(Applicable only to hardware/software purchases or related services)This contract has been revtewe
Technology Director as to technical content and information technology specifications:
IT a ure: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required El. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorp ation of Insurance provisions as shown, this contract is approved
by the Risk Manager: C'e
Risk Manager's Signature: Date: J,tI4 '3
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No N 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: a�w //. Date: R lz Is
County Attorney
Approval by Board ❑ (Contracts $90,000 0 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Man a er P(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has be ev'ewe pproved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: I"
County Manager
This contract has been reviewed and is ve the ount Manager Yes o❑.
This contract has been reviewed a fo i at a the it e 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 120
Clerk's Signature: Date:
Revised March 2012