HomeMy WebLinkAboutR 2014-392 DSS - Premier Home Health Care Services, Inc. to perform in-home health services 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: Premier Home Health Care Services,Inc. Party/Vendor Contact Person: Gregory Turchan/Kathleen Craig Contact
Phone:(919)428-7722 Party/Vendor Address:445 Hamilton Ave. 10th Floor City White Plains State:NY Zip: 10601 Department:
DSS Amount: $415,647 Purpose:Perform In-Home health services Budget Code(s): 10400220-63000 Vendor# (N/A if new
vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: C ck one)New❑ Renewal® Amendment ❑ Effective
Date 07/01/2014 Approved by Board Yes2 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: 6TjQ-1_(4
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 sho
by the Risk Manager: D M
Risk Manager's Signature:
a-�e Date /1K JUL 2 5 2014
Financial Services Z:p
This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[� A bu amnd�wnt is nP�A�c T
before approval Yes❑Novi, budget amendment is necessary,please attach to this form. This instrument has been pre-audited m the
manner required by the Local Government Bud et and Fiscal Control ,,t-
Financial Services Director's Signature: �' J1''". . 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 Managerx(Most other contracts$1,000 and above). Department Director approval only ❑(Under,,
$1,000). This contract has b view approved by the Attorney as to legal form and sufficiency:—gqy, V''
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Attorney's Signature Date: I 3o — Sl 1Z 13
County Manager
This contract has been reviewed and is approved by the County Manager Yes[ Nom.
This contract has been reviewed and is for z7rwz�No❑.
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Manager's Signat ure: Date:
l
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