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C�A - _ <br /> 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: KAH Care.LLC dba Right at Home Party/Vendor Contact Person: Kenneth Helmuth Contact Phone: 919-241- <br /> 5292 Party/Vendor Address: 105 W.Corbin St City Hillsborough State:NC Zip:27278 Department:DSS Amount: not to exceed <br /> $80,000 Purpose: In-home services Budget Code(s): 10400220-630000 Vendor# (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes❑No❑ Contract Type: (Check one)New❑ Renewal ❑ Amendment ❑ Effective Date Approved by <br /> Board Yes❑No® Agenda Date: 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: <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 ❑. With incorporation of Insurance provisions as sl hk contract d <br /> by the Risk Manager: <br /> Risk Manager's Signature: 1,0 Date: / qpp 1 2014 <br /> -q411 ` <br /> Financial Services <br /> This Contract is conditioned 9pon appropriation by the Board of Commissioners Yes❑NoV A <br /> before approval Yes[:] No[g. 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: <br /> Financial Services Director's Signature: U"_t, Date: j i i' q <br /> x-11) <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 X (Most other contracts$1,000 and above). Department Director approval only ❑ (Under <br /> $1,000). This contract has bi and approved by the Attorney as to legal form and suffic' nc <br /> Attorney's Signature Date: 1 <br /> County Manager � <br /> This contract has been reviewed and is ap ve y the County Manager Yes9<0n. <br /> This contract has been reviewed an is f r ig e b t Ye No❑. <br /> Manager's Signature: Date: <br /> //4- 4� <br /> Clerk to the Board <br /> Approved by BOCC on the day of 20 . Submitted for Chair signature on the day of 120 <br /> Clerk's Signature: Date: <br /> Revised March 201.2 <br />