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5 <br /> U N C <br /> CONTRACT ROUTING FoRm <br /> Parties: UNC Health System Properties, LLC and Orange County Contract#: <br /> Term: Effective 01/01/11 - 06/30/111 <br /> ®New ❑Renewal ❑Amendment ❑ Termination <br /> ❑Accounts Payable ❑Accounts Receivable <br /> Purpose of Contract: In return for valuable consideration Health System Properties, LLC <br /> will pay $18,205.73 as a fixed amount oti an annual basis for the roperty located at 1350 <br /> Raleigh Road. �, �� "� 'wr " �� M <br /> Dept.: Strategic Planning Dept. Contact: Mary Beck Phone: 966-4038 <br /> REV'I 'W itm ftllowit� order): <br /> r <br /> , L ;ercsifden!?66 <br /> ort or Purchasing <br /> � ld Hospitals Date <br /> ylvi hibaut,) (Gar -lark) <br /> Depat°tn nt m -c or Date HS'P President Date <br /> (Mmtr ;heck) (William L. Roper <br /> 3. <br /> Property Committee Date <br /> (Mel Hurston) / �2 <br /> Contract to be signed by the CEO of the UNC Health care System or his/her designee <br /> following the completion of this form. <br /> Copy to Purchasing on: Copy to Department on: <br /> Date "` -/9 / Date jr d, <br /> V.rc.°..... "3` �,_✓��8 li".i�.A%dY J'�H"-f��"a�'... <br /> PERSON REQUESTING CONTRACT: (Ray Lafrenaye) <br /> 1. Terms of Contract: 01/O1/11 - 06/30/111 <br /> 2. If payment to be paid by Health System Properties LLC: HSP Account <br /> Enter Cost Center/Dept: <br /> 3. Total Estimated Costs: $18,205.73 <br /> Please return signed routing and contract originals to Ray Lafrenaye,Facility Planning&Development <br />