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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: Magellan Behavioral Health,Inc. Party/Vendor Contact Person: Karen Friedman Contact Phone:314-387-4258 <br /> Party/Vendor Address:Magellan Lockbox#785341,Post Office Box 785341 City Philadelphia State:PA Zip: 19178-5341 <br /> Department: Amount:$15,456.00 Purpose:Employee Assistance Program Budget Code(s): 10250020/630000 Vendor# 19781 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New® Renewal❑ Amendment <br /> ® Effective Date 1/1/2014 Approved by Board Yes❑No® Agenda Date: Title of Contract:Amendment to Ma eg_llan <br /> Behavioral Health,Inc.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: 12ioAj Date: <br /> IT Direct®r <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 Insuran With incorporation of Insurance provisions as sho <br /> by the Risk Manager: ce D <br /> _ a <br /> Risk Manager's Signature: FHB — 2013 <br /> 14 <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[V]/ A bu <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: /G <br /> Financial Services Director's Signature: t,� G Z . Date: <br /> -:?/1+ <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). Approva by Manager (Most other contracts$1,000 and above). Department Director approval only❑ (Under <br /> S1,000). This contract has ben evi e nd 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 ' ap rovW by the Coun Manager Yes io❑. <br /> This contract has been reviewed is f si tur b the air s❑No❑. <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 />