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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: NC HIE Party/Vendor Contact Person: Jayson Caracciolo Contact Phone: Party/Vendor Address:2300 <br /> Rexwoods Drive Suite 390 City Raleigh State:NC Zip:27607 Department: Public Health Amount: A S1 Purpose: <br /> Provider will be engaged in overseeing administration and operation of an electronic health information exchange network Budget <br /> Code(s): 10410020-630000 Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check <br /> one)New® Renewal ❑ Amendment ❑ Effective Date January 1,2014 Approved by Board Yes❑No❑ Agenda Date: <br /> Title of Contract: Technology-Enabled Care Coordination <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 /> � ` G IDepartment Director's Signature: Date: — 0 <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 shown,this contract is approved <br /> by the Risk Manager: <br /> Risk Mana Zl7 ger's Signature: A7- ks Date: <br /> Financial Services <br /> This Contract is conditioned on appropriation by the Board of Commissioners Yes❑No[ A budget amendment is necessary <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 Budg t and Fiscal Control Acts,L u <br /> Financial Services Director's Signature: Date: S 5 T <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 a y BOCC <br /> consultant contract). Appro 1 by Manager❑ (Most other contracts$1,000 and above). Department Director approval only (Under <br /> $1,000). This contract has a revi a and approved by the Attorney as to legal form and sufficiency: <br /> Attorney's Signature Date: <br /> County Manager FEB -7 2013 <br /> This contract has been reviewed and is approved by the County Manager Yes❑No❑. <br /> This contract has been reviewed and is for signature by the Chair Yes❑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 />