HomeMy WebLinkAboutR 2014-537 ES - Physio-Control, Inc. for Technical Support Agreement ..2c�1�•-537
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: Physio Control Party/Vendor Contact Person: Lane Rushine Contact Phone:425-867-2368 Party/Vendor
Address: 11811 Willows Road NE City Redmond State: WA Zip: 98052 Department: Orange County Emergency Services Amount:
$16,688.00 Purpose:Technical Support Agreement Budget Code(s): 10757520-571000 Vendor#45414 (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:
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 T • contract has been reviewed and approved by the Department Director as to
technical content: !J
Department Director's Signature: Date: �� 7
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
Risk Manager's Signature: u Date- l OCT 16 2014
Financial Services
This Contract is conditioned ypon appropriation by the Board of Commissioners Yes❑No[2/ A bu B
before approval Yes❑NoLY. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Control Act:
Financial Services Director's Signature: a"--< , Date: 10 l'7
County Attornev
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 anagerk(Most other contracts$1,000 and above). Department Director approval only❑ (Under
$1,000). This contract has bee r wed and approved by the Attorney as to legal form and sufficiency Q_
Attorney's Signature Date: lO 1_1 1 1
County Manager
This contract has been reviewed and is approved by the County Manager Yes �NoFEJI.
This contract has been reviewed and is for si ature by the Chair Yes❑No❑.
Manager's Signature: Date: a A3
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