Orange County NC Website
Browse       Search
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: Starpoint global Service Party/Vendor Contact Person: Richard Ray Contact Phone:919-933-9529 Party/Vendor <br /> Address: 1 Ashley Wade Lane City Chapel Hill State:NC Zip:27516 Department:Public Health Amount: $33,350 Purpose:Imag_in <br /> Patient Records and Other Servicesas provided in Estimated Cost and Service Proposal Budget Code(s):61-3700-35-800100-30012 <br /> Vendor#690039 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New® Renewal <br /> ❑ Amendment ❑ Effective Date October 21,2013 Approved by Board Yes❑No❑ Agenda Date: Title of Contract: <br /> Business Associate 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: le-4 <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 Required ❑. Hold <br /> Contract pending receipt of Certificate of Insurance ❑. Wit®h iinco_rporation of Insurance provisions as shown,this contract is approved <br /> by the Risk Manager: e <br /> Risk Manager's Signature: l�C� /`- -�`'�- Date: /.6 Z� <br /> Financial Services <br /> This Contract is conditioned Aon appropriation by the Board of Commissioners Yes❑ .No A budget amendment is necessary <br /> before approval Yes[]NoIf 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:r 1 <br /> Financial Services Director's Signature: '-w �� Date: <br /> 10 1 Z8 <br /> County Attorney <br /> Approval by Board ❑ (Contracts $90,00010J 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 51,000 and above). Department Director approval only❑(Under <br /> $1,000). This contract has be i d d approved by the Attorney as to legal form and suffici ncy: <br /> Attorney's Signature Date: 1 1 I <br /> County Manager <br /> This contract has been reviewed and is a P ro by the County Manager Yes lo❑. <br /> This contract has been reviewe is r s' atur the it Y No❑. <br /> c.i <br /> Manager's Signature: Date: <br /> 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 /> Revised March 2012 <br />