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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Lesly Penick Party/Vendor Contact Person: Contact Phone: 919-274-4530 <br /> Party/Vendor Address: 221 Adams Street City: State: NC Zip: 27513 Department: Health Amount: <br /> Purpose: Budget Code(s): Vendor# 58092 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑ Amendment ® Effective Date 10/17/2014 <br /> Approved by Board Yes❑Non Agenda Date: <br /> This agreement is approved as to technical form and it <br /> Department Director's Signature �... Date: <br /> 1n n Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Director of Information Technology Date: <br /> Risk Management D � � � 0 <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirem <br /> OCT 1 6 2014 <br /> Office of Risk Management _ t �_�..� Date: <br /> 101 L10 By <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officers Date: <br /> t0�� <br /> Lesal Services <br /> This agreement is approved as to lega and sufficiency: <br /> Office of the County Attorney Date: O 28 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br />