HomeMy WebLinkAboutR 2014-384 DSS-Aging - KAH Care, L.L.C. to perform in-home services for DSS Clients and Dept. on Aging Clients r
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. Contract, for legal review should
be completed through the legal review process prior to being routed for signature.
Department
Party/Vendor Name: KAH Care,L.L.0 Party/Vendor Contact Person: Kenneth Helmuth Contact Phone: 9t 191:x41-5292 Party/Vendor
Address: 105 W. Corbin St Suite 203 City Hillsborough State:NC Zip:27278 Department: DSS Amount:J4 5.647 Purpose:Provide
employees to perform in-home services for DSS clients and Dept on Aging clients Budget Code(s): 10400220-6 10000 Vendor#
(N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New❑ Renewal® Amendment
❑ Effective Date 07/01/14 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: G Date:
T Director
(Applicable only to hardware/software purchases or related services)T�his contract has been reviewed and approved by the Information
Technology Director as to technical content and information tech n gy specifications:
IT Director's Signature: Date:
Risk Mana cement r
Include the following coverages: D-CGL;4�Mto; ®''WC; rofessional; rl 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:
QD
Risk Manager's Signature: 1 Date:
71z:l JUL 21 2014
Financial Services
This Contract is conditioned j4pon appropriation by the Board of Commissioners Yes❑NoE% A bud mendment is necessary
before approval Yes❑No M. If budget amendment is necessary,please attach to this form. This instrument
manner required by the Local Government Budget and Fiscal Cool Act*
Financial Services Director's Signature: ' Date: I l
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 nager❑(Most other contracts$1,000 and above). Department Director approval only❑(Under
$1,000). This contract has been re i ed and approved by the Attorney as to legal form and sufficiency: Q�1�_
Attorney's Signature Date: �L
County Manager
This contract has been reviewed and is approved by the County Manager Yes No❑.
This contract has been reviewed and is for signatujr�by the Chair Yes❑No❑.
Manager's Signature: Date:
Clerk tot oard
Approved by BOCC on the T day of ,20 . Submitted for Chair signature on the_day of ,20
Clerk's Signature: Date:
Revised March 2012