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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 /> V <br /> Department —�tz_- <br /> Party/Vendor Name: Pata onia Health Inc Party/Vendor Contact Person: Ashok Mathur Contact Phone:919-622-6740 Party/Vendor <br /> Address:202 Midenhall Way City Cary St e:NC Zip:27513 artment:Health Amount: $40,500/startup&$3,764/month Purpose: <br /> Electronic Medical Record Budget Code(s): Ven W, if new vendor) Vendor is a BOCC consultant? Yes F-1 No[D <br /> _ <br /> Contract Type: (Check one)New[] Renewal Q Amendment F-1 Effective Date 10-24-2012 Approved by Board YesX NoF1 <br /> Agenda Date: Title of Contract: <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/P,FPs 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: L Date: ic V 1� <br /> IT i irector <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 Man3gement <br /> Include the following coverages: ffyCGL; [Auto; Eg-VC; [i; Professional; M Property; OR No Insurance Required F-1. Hold <br /> r' <br /> Contract pending receipt of Certificate of Insurance 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❑NoEg/ 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 Budge l and Fiscal Control ct* <br /> Financial Services Director's Signature: Date: 3j) <br /> County Attorney <br /> Approval by Board F-1 (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approval by Manager A(Most other contracts$1,000 and above). Department Director approval only F-1 (Under <br /> $1,000). This contract has evie d Vd approved by the Attorney as to legal form and sufficiency- <br /> Attorney's Signature Date: <br /> County Manner <br /> This contract has been reviewed and is approved by the County Manager YesDINO❑. <br /> This contract has been reviewed and is for signature by the Chair,YesmNoal*, <br /> Manager's Signature: Date: <br /> Clerk Yo the Board <br /> Approved by BOCC on the day of 120 Submitted for Chair signature on the day of 20 <br /> Clerk's Signature: Date: <br /> Revised March 2012 <br />