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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: EMS Management&Consultants Party/Vendor Contact Person: Samantha Travis Contact Phone: 336-766-1279 <br /> Party/Vendor Address: PO Box 863 City Lewisville State:NC Zip:27023 Department: Tax Administration Amount: 0.00 Purpose: <br /> Update Business Associate Agreement in reference to HIPAA Budget Code(s):_ Vendor 9 59733 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑NoE Contract Type: (Check one)New❑ Renewal ❑ Amendment Z Effective Date September 1, <br /> 2012 Approved by Board Yes❑NoZ 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/RFPs received YesE]NoD Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Si nature- � Date: 12,11011 <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; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Re uired 0 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: A^ Date: 2-- <br /> lei it—liz. <br /> Financial Services <br /> This Contract is conditioned Oon appropriation by the Board of Commissioners Yes❑Nod A budget amendment is necessary <br /> before approval Yes[]No[V. 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 Bud et and Fiscal I Act: <br /> Financial Services Director's Signature: V014LL—1 Co 7, A— Date: /2-/1 <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,00 00 or more for goods or services, $250,000.00 or more for construction, or any BOCC <br /> consultant contract). Approyal by Manage(Most other contracts$1,000 and above). Department Director approval only El (Under <br /> $1,000). This contract has e revi d d approved by the Attorney as to legal form and sufficle icy: <br /> Attorney's Signature Date: 14 — <br /> County Manage <br /> This contract has been reviewed and is approved by the County Manager Y04-1,Nom. <br /> This contract has been reviewed and is for sign sRNqff._ <br /> Manager's Signature: Date: rt <br /> lerk to the Board <br /> Approved by BOCC on the_day of 20 Submitted for Chair signature on the day of 20 <br /> Clerk's Signature:— Date: <br /> Revised March 2012 <br />