HomeMy WebLinkAboutR 2014-147 ES -UNC Health Care Systems for Business Associate Agreement =-�0)4 - l47
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: UNC Health Care Systems Party/Vendor Contact Person: Jeffrey M.Yardley Contact Phone: 919-957-5791
Party/Vendor Address:4400 Emperor Boulevard City Durham State:NC Zip:27703 Department:UNC Health Care System
Purchasing Department Amount: Purpose:Business Associate Agreement Budget Code(s): Vendor# (N/A if new
vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective
Date 09/23/2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract:
If this is a Grant Agreement,pre-application has been approved by t Board of Commissioners Yes❑No❑. If submitted for bid were
bids/RFPs received Yes[]No❑ Bid/RFP num This co ct has been reviewed and approved by the Department Director as to
technical content:
Department Director's Signature: Date: J-d- o(ItlY
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:_�� 1A Date:
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑NoD/ 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: �"L4 G-` �� �;�4111 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). Approval by Manager❑ (Most other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has been revi ed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date: �q
� � 15ll L'1
County Manager
This contract has been reviewed and is a ro by the County Manager YesC No❑. FEB 2 4 2013
This contract has been reviewed s f si n ure th air es❑No❑.
Manager's Signature: Dat
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