2012-038 Human Resources - Delta Dental $460,000

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f ORANGE COUNTY—CONTRACT CONrROL SHEET �� ~ .,.... Routing Order: l Department, 2 IT, 3 Disk Management, Financial Services, 5 .homey, Manager, 7 Clerk This Document shall accompany all contracts and shall he subirdtted for signature in the Routing Order specified above. If the Manager detei ines the contract is not appropriate for Manager approval the Manager shall subunit 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 he completed through the legal review process prior to being routed for signature. Department Party/ vendor Name: Delta I ental Party /Vendor Contact Person: Stephanie Morris Contact Phone: 919 424-1047 PartyNendor Address: 343 E. Six Forks Rd. City Raleigh State: NC' dip: 27609 Department: Human Resources Amount: $460,000 Purpose: Dental claims and administrative fees Budget Code(s): Vendor #-50221 (N/A if new vendor) Vendor is a BOCC consultant' Y To tract Wy_p_�. ec one) New ❑ Renewal M Ar r dment ❑ Effective Date 1/1/2012 Approved by Board Yes ❑ Igo ❑ Agenda Date: Title of Contract: Delta Dental Service Contract If tMs is a Grant Agreement, pre-application has been approved by the Board of Conumissioners. Yes❑ � ❑. If submitted for bid were bids/RFPs received Yes[:] l o❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: Department Director's Si nature: �.. �� Date: IT Director (Applicable only o rdwa • ftwar 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 fle I ni-A Include the following coverages: El CGL; El Auto; ❑ WC; Professional; ❑ Property; OR No Insurance Re Hold Contract pending receipt of Certificate of Insurance E]. with incorporation of Insurance provisions as shown, this contract is approved by the Risk Manager: Risk Manager's Signature: Date: b"Z "�Z i - o;— P,w l � . Financial Services TMs Contract is condition upon appropriation by the Board of Commissioners Y s❑I o A budget amendment i necessary before approval Yes❑ Io If budget amendment is necessary, please attach to this foam.. ` instrument has been pre-audited in the manner required by the L cad ov nun nt Budget and Fiscal Control Act: Financial Services Director's Signature: Date: County Attorney Approval by Bo rrd (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or an y B C consultant contract). Approval by Manager ❑ (All th r contracts). This contract has been reviewed and approved by the Attorney as to legal form and sufficiency: Attorney's Signature Date: Coun!y Manner This contract has been reviewed and is approved by the County Manager Yej�7No This contract has been reviewed and is for signature by the Chair Yes❑ o❑r Manager's Signature: Date. Clerk W t1w Board Approved by BOCC on the clay of > 20 _ . b I ih#ed for Chair signature on the day of , 2 �. Clerk's Signature: Date: Revised November 2011