HomeMy WebLinkAboutR 2014-418 DSS - CNC/Access, Inc dba ResCare Home Care to orovide in-home health services for DSS clients �-l8
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: CNC/Access,Inc dba ResCare Home Care Party/Vendor Contact Person: Malissa Pompey Contact Phone: 704
405-9035 Party/Vendor Address: 830 Tyvola Rd suite 104A City Charlotte State:NC Zip:28217 Department:DSS Amount:
$415,647 Purpose:Provide in home health services for DSS clients 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: 07
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 roved
by the Risk Manager: D � @ � D T T
1
Risk Manager's Signature: Date: AUG — 5 2014
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Financial Services ��-
This Contract is conditioned pon appropriation by the Board of Commissioners Yes❑No[� A bu amendment is necessary
before approval Yes[:]No[. If budget amendment is necessary,please attach to this form. This instrument has been pre-au ite to e
manner required by the Local Government1ludget and Fiscal Control Act:Financial Services Director's Signature: 0 A. Date:
County Attorney
Approval by Board ❑ (Contracts $90,000.99 or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval by Ma er (Most other contracts$1,000 and above). Department Director approval only ❑ (Under
$1,000). This contract has been revie e d ved by the Attorney as to legal form and sufficiency:
Attorney's Signature Date:
County Manager
This contract has been reviewed and is approved by the County Manager Yes /Noo.
This contract has been reviewed and is fo gnature by the Chair Yes❑No❑.
Manager's Signature: Date:
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