HomeMy WebLinkAboutR 2014-436 Finance - Duke HomeCare & Hospice - Outside Agency Performance Agreement ORANGE CONTROL SHEET
Routing Order: (|)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. lf the Manager
determines the contract is not appropriate for Manager approval the Manager shall submit the contract for B0CCoppzovui 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
Purty/VeodnrNumo: Duke HomeCare&Hospice Party/Vendor Contact Person: Dale Horton Contact Phone:0l9-620-3853
Party/Vendor y� �byl��b�� �t����C Zip:27704 Department:Finance&Admin. Services
Nuf�ose:Performance Agreement Budget Code(s): 10495050-710026 Vendor# 50707 (N/A if new vendor) Vendor is a
Amount. e
BOCC consultant? Yes Fj NoZ Contract Type: (Check one)New F-1 Renewal Z Amendment [] Effective Date 7/1/2014
Approved by Board Yeso NoF1 Agenda Date, 6/17/2014 Title of Contract:2014-15 Outside Agency Performance Agreement
� u this mu Grant Agreement, pre-application has been approved by the Board of Commissioners YenE]Noo. 1f submitted for bid were
bidaDlFpo received YnsF�7VoFl Qid/8Fy number This contract has been reviewed and approved hy the Department Director uo0n
technical content:
Department Director's Signature: Date:
IT Director
(Applicable only m6ur6*uru6cftwo,e purchases or related services)This contract has been reviewed and approved hy the Information
Technology Director as to technical content and information technology specifications:
JT Director's Signature: Date:
Risk Manaaemen
Include the following coverages: F] CGL; F-1 Auto; r_1 VC; F� Professional; F� Property; OR No Insurance Required R. Hold
Contract pending receipt of Certificate n[Insurance With incorporation ut Insurance provisions ua shown,this contract isapproved
6y the Risk Manager:
Risk Manager's Signature: Date: 2�;�
AUG 19 2014
Financial Services
This Contract is conditioned on appropriation by the Board of Commissioners YesE]No2l/ A b t amendment is necessa
If budget amendment is necessary,please attach to this form. This instrumeh"....b e...
before approval YcsF�No-V
manner required by the Local Government Budget Fiscal Control Act:
Financial Services Director's Signature: Date: hy
County Attornev
Approval by Board 0 (Contracts $90,000)..Op or more for goods or services, $250,000.00 or more for construction, or any BOCC
consultant contract). Approval b , Z (Most other contracts$1,000 and above). Department Director approval only r_1(Under
$1,000). This contract has been ev* wed and approved by the Attorney as to legal form and sufficiency:
Attorney's Signature M — Date:
If I County Manage
This contract has been reviewed and is approved by the County Manager Y%4oa
This contract has been reviewed and is f r signature by the Chair YesF�NoFl.
Manager's Signature: Date:
Clerk t9he Board
Approved by BOCC on the_day of 20_. Submi hair signature on the Pay of 20__.
Clerk's Signature: Date: fiv
Revised March 2012