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ORANGE COUNTY-CONTRACT CONTROL SHEET <br /> Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk <br /> This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager <br /> determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for <br /> BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should <br /> be completed through the legal review process prior to being routed for signature. <br /> Department <br /> Party/Vendor Name: Physio Control Party/Vendor Contact Person: Lane Rushing Contact Phone: 18004421142 Party/Vendor <br /> Address: 11811 Willows Rd.NE City Redmon State: Washington Zip:98052 Department: Emergency Services Amount: $32,718 <br /> Purpose: Service Contract Budget Code(s): 1075752057 1000 Vendor 9 45414 (N/A if new vendor) Vendor is a BOCC consultant? <br /> YeSE]NoE Contract Type: (Check one)New❑ Renewal Z Amendment ❑ Effective Date July 1,2012 Approved by Board <br /> Yes❑No[g Agenda Date: Title of Contract:Technical Service Support Agreement <br /> If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted for bid were <br /> bids/RFPs received Yes❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: A c6Z Date: <br /> IT Director <br /> (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information <br /> Technology Director as to technical content and information technology specifications: <br /> IT Director's Signature: Date: <br /> Risk Management <br /> Include the following coverages: ❑ CGL; E] Auto; ❑ WC; E] Professional; ❑ Property; OR No Insurance Required E� Hold <br /> Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Manager's Signature: Date: <br /> Financial Services <br /> This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑Noy A budget amendment is necessary <br /> before approval Yes❑No . If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the <br /> manner required by the Local Government Budget and Fiscal Control Act: <br /> Financial Services Director's Signature:qw� I � Date: <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). �by Manager (Most other contracts$1,000 and above). Department Director approval only El (Under <br /> y <br /> W <br /> $1,000). This contract __ revi a approved by the Attorney as to legal form and suffic�*ency. <br /> Attorney's Signature Date: <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Yes2lNo❑. <br /> This contract has been reviewed and is for signature by the Chair Yes❑NoEJ' <br /> Manager's Signature: Date: <br /> erk to the Board <br /> 'W� <br /> S mit or <br /> Approved by BOCC on the—day of 2 Submitted for Chair signature on the v day of 120 . <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />