HomeMy WebLinkAboutR 2014-396 DSS - Senior Care of Orange County, Inc. to provide adult day health services to DSS clients 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: Senior Care of Orange County,Inc Party/Vendor Contact Person: Alvonia Baldwin Contact Phone: 919-245-2017
Party/Vendor Address:P.O.Box 8181 City Hillsborough State:NC Zip:27278 Department:DSS Amount: $20,000 Purpose: Provide
Adult Day Health Services to DSS clients Budget Code(s): 10405020-764100 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: Senior Care of Orange Coun ,Inc.
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: n7—olS`/µ
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 Manaeement
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Ins u auce old
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shows Rl i�c i is aTrt�
by the Risk Manager: U
Risk Manager's Signature: Date: JUL 2 9 2014
Financial Services By
This Contract is conditioneVi on appropriation by the Board of Commissioners Yes❑No(( A budget amendment is necessary
before approval Yes[]No f budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budge and Fiscal Contr Act:
3 /
Financial Services Director's Signature: N!2_W V,/Q Date: r
11-so
County Attorney
Approval by Board ❑ (Contracts $90,000.0p or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by a ager Pq (Most other contracts$1,000 and above). Department Director approval only ❑(Under
$1,000). This contract has been rei roved by the Attorney as to legal form and sufficie cy:
Attorney's Signature Date: 3)
County Manaeer
This contract has been reviewed and is approved by the County Manager Yes No❑.
This contract has been reviewed and is for signature by the Chair Yes❑No❑.
Manager's Signature: - - 1 Date: r
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