HomeMy WebLinkAboutR 2014-143 HR - Megellan Behavioral Health Inc for Employee Assistance Program 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: Magellan Behavioral Health,Inc. Party/Vendor Contact Person: Karen Friedman Contact Phone:314-387-4258
Party/Vendor Address:Magellan Lockbox#785341,Post Office Box 785341 City Philadelphia State:PA Zip: 19178-5341
Department: Amount:$15,456.00 Purpose:Employee Assistance Program Budget Code(s): 10250020/630000 Vendor# 19781
(N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New® Renewal❑ Amendment
® Effective Date 1/1/2014 Approved by Board Yes❑No® Agenda Date: Title of Contract:Amendment to Ma eg_llan
Behavioral Health,Inc.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: 12ioAj Date:
IT Direct®r
(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 Insuran With incorporation of Insurance provisions as sho
by the Risk Manager: ce D
_ a
Risk Manager's Signature: FHB — 2013
14
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[V]/ A bu
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: /G
Financial Services Director's Signature: t,� G Z . Date:
-:?/1+
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 by Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under
S1,000). This contract has ben evi e nd approved by the Attorney as to legal form and suffic'ency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and ' ap rovW by the Coun Manager Yes io❑.
This contract has been reviewed is f si tur b the air s❑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