HomeMy WebLinkAboutR 2014-183 DSS - KAH Care, LLC dba Right at Home for in-home services C�A - _
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: KAH Care.LLC dba Right at Home Party/Vendor Contact Person: Kenneth Helmuth Contact Phone: 919-241-
5292 Party/Vendor Address: 105 W.Corbin St City Hillsborough State:NC Zip:27278 Department:DSS Amount: not to exceed
$80,000 Purpose: In-home services Budget Code(s): 10400220-630000 Vendor# (N/A if new vendor) Vendor is a BOCC
consultant? Yes❑No❑ Contract Type: (Check one)New❑ Renewal ❑ Amendment ❑ Effective Date Approved by
Board Yes❑No® Agenda Date: Title of Contract: In-Home Aide Provider Services 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:
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 sl hk contract d
by the Risk Manager:
Risk Manager's Signature: 1,0 Date: / qpp 1 2014
-q411 `
Financial Services
This Contract is conditioned 9pon appropriation by the Board of Commissioners Yes❑NoV A
before approval Yes[:] No[g. 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: U"_t, Date: j i i' q
x-11)
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 X (Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has bi and approved by the Attorney as to legal form and suffic' nc
Attorney's Signature Date: 1
County Manager �
This contract has been reviewed and is ap ve y the County Manager Yes9<0n.
This contract has been reviewed an is f r ig e b t Ye No❑.
Manager's Signature: Date:
//4- 4�
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 201.2