R 2014-419 DSS - Personalized Patient Home Assistance Inc to provide in-home health care assistance to DSS clients

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ZOV4-�tlq ORANGE COUNTY-CONTRACT CONTROL SHEET Routing Order: (1)Department,(2)IT,(3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager,(7)Clerk This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for BOCC approval must be submitted through,and complete,the routing process prior to agenda review. Contracts for legal review should be completed through the legal review process prior to being routed for signature. Department Party/Vendor Name: Personalized Patient Home Assistance Inc PartyNendor Contact Person: Dorthea Farrington Contact Phone: 919- 929-4943 Party/Vendor Address: 109 Concord Dr City Cha ep 1 Hill State:NC Zip:27516-3216 Department:DSS Amount: $415,647 Purpose:Provide in-home health care assistance to DSS clients Budget Code(s): 10400220-63000 Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/14 Approved by Board Yes❑No❑ Agenda Date: Title of Contract:In-Home Aide Provider Services Agreement If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No❑. If submitted for bid were bids/RFPs received Yes❑Non Bid/RFP number This contract has been reviewed and approved by the Department Director as to technical content: or Department Director's Signature: Date: O-)-aa-/'4 IT Director (Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information Technology Director as to technical content and information technology specifications: IT Director's Signature: Date: Risk ManaEement Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; ❑ Professional; ❑ Property; OR No Insurance Required ❑. Hold Contract pending receipt of Certificate of Insurance E]. With incorporation of Insurance provisions as shown, this contract is approved by the Risk Manager: Q� Risk Manager's Signature: Date: Financial Services This Contract is conditioned 9pon appropriation by the Board of Commissioners Yes❑No[v A budget amendment is necessary before approval Yes❑NoLV. budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Financial Services Director's Signature: FS[t1 County Attorney Approval by Board ❑ (Contracts $90,000.00 or more for goods or services, $250,000.00 or more for construction, or any BOCC consultant contract). Approval ManagerDjr(Most other contracts$1,000 and above). Department Director approval only ❑ (Under $1,000). This contract has b r iewe "pproved by the Attorney as to legal form and suffici ncy: i Attorney's Signature Date: �'— County Manaaer This contract has been reviewed and is approved by the County Manager Yes No❑. This contract has been reviewed and is signature b the Chair Yes❑No❑. Manager's Signature: Date: D ' Clerk o the Board Approved by BOCC on the day of ,20 . S i ed for Chair signature on the day f ,20 Clerk's Signature: Date: Revised March 2012