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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: Personlized Patient Home Assistance Party/Vendor Contact Person: Dorthea Farrineton Contact P <br /> 929-4943 Party/Vendor Address: 109 Concord Drive City Chapel Hill State:NC Zip: 27516 Department: DSS A unt: $415,647--� <br /> Purpose: In home services Budget Code(s): 10400220630000 Vendor# 17354 (N/A if new vendor) Vendor is BOCC nt? <br /> Yes❑No❑ Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 07/01/13 Approved by Board Yes <br /> ®No❑ Agenda Date: 05/07/13 Title of Contract: In-Home Aide Provider Services 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❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to <br /> technical content: <br /> Department Director's Signature: Date: 7 <br /> 1 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 /> isk Management <br /> Include the following coverages: VCGL; [Auto; 56 WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold <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 /> 614 <br /> Risk Manager's Signature: �l n�"V� 12 13 <br /> ^�'� �' Date: J <br /> . -t[z�[13 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes[ budget amendment is necessary <br /> before approval Yes❑ No�lf 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 Contr Act: <br /> Financial Services Director's Signature: <br /> N-14.9/ Date: / 74 I <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). Approval by Manager% (Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). Tcontract has bee viewed and approved by the Attorney as to legal form and suffi iency: <br /> Attorney's Signature Dater <br /> County Manager <br /> This contract has been reviewed and is approved by the County Manager Ye No❑. <br /> This contract has been reviewed and is for signature the Chair Yes❑NoQ./ <br /> Manager's Signature: Date: <br /> �r Clerk 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 /> RHviSed M arch 2012 <br />