HomeMy WebLinkAboutR 2011-021 Health - AccessCare provider network support ORANGE COUNTY—CONTRACT CONTROL SHEET S(.NO• 2-1
Routing Order: (1) Department, (2) IT, (3) Risk Management, (4)Financial Services, (5)Attorney, (6) Manager, (7)Clerl<
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: AccessCare. Party/Vendor Contact Person: Anita Hill. Contact Phone: 919-966-5941. Party/Vendor Address: PO
3000 Ariel Center Parkway Suite 101. City Morrisville. State: NC Zip: 27560 Department: Health Amount: Purpose: Provider
Network Support Budget Code(s): 141402063000 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant`? Yes ❑ No
Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date 12/1/2010.
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:
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 Mana ement
Include the following coverages: ❑ CGL.; ❑ Auto; ❑ WC; Professional; ❑ Property; ❑ OR No Insurance Required old
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: (,(/1N1 Date: / • �G /d
Financial Services
This Contract is condition d upon appropriation by the Board of Commissioners Yes❑No ]. A budget amendment is necessary
before approval Yes❑Not. 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,,r-> Date:
County Attorney
Approval by Board ❑ (Contr cts over $25,000.00 or any BOCC consultant contract). Approval by Manager ❑ (All contracts
$25,000.00 or less with the ex ep 'on of CC consultants). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
Attorney's Signature Date: l
County Manager
This contract has been reviewed and is approved by the County Manager Ye No❑.
This contract has been reviewed and is to be submitted fo•BOC considera on Yes❑NaO�
Manager's Signature: Date:
r rk to the Board
Approved by Board Yes❑No genda Date: "� l
' Signature: Date: *�
Clerk's S g