HomeMy WebLinkAboutR 2010-072 Co Manager - Senior Care of Orange County outside agency agreement ORANGE COUNTY—CONTRACT CONTROL SHEET 0,7 a
Routing Order: (1)Department, (2)IT, (3)Risk Management, (4)Financial Services, (5)Attorney, (6)Manager, (7)Cleric
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 Party/Vendor Contact Person: Alvonia Baldwin Contact Phone: 919-245-2017
Party/Vendor Address: 515 Meadowlands Dr., Ste 500 City Hillsborough State:NC Zip: 27278 Department: Outside Agency Amount:
$42,000 Purpose: Budget Code(s): 10495050 719027 Vendor 4 800047 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑No® Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date July 1,2010 Approved by Board
Yes®No❑ Agenda Date: June 15,2010 Title of Contract:2010-11 Outside Agency Performance 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: cl,J ( Date: — (�
IT Direc
(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 El. Hold
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: Date: �' C)
Financial Services
This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No6(. A budget amendment is necessary
before approval Yes❑Nol 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 Sery i ce s Director's Signature: a"Ito." / Date:
County Attorney
Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Manager ❑ (All other contracts). This contract has been reviewed and approved 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❑No❑.
This contract has been reviewed and is to be submitted for BOCC consideration Yes❑No❑.
Manager's Signature: Date:
Cleric to the Board
Approved by BOCC on the day of 20 . Submitted for Chair signature on the day of ,20
Cleric's Signature: Date: C6 Hit
Revised April 2010