R 2015-315-E DSS - UNC Hospital to provide one full time IMC and one part-time supervisor

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DocuSign Envelope ID: 58D1CF8D-AFE2-4E9F-83A1-A478FC8BEB36 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: UNCH Party/Vendor Contact Person: J.J Campbell Contact Phone: (919) 966-7029 Party/Vendor Address: 101 Manning Dr City Chapel Hill State: NC Zip: 27278 Department: DSS Amount: $49,587 Purpose: Provide one full time IMC and one wart-time supervisor Budget Code(s): 10403005-442311 Vendor# (NIA if new vendor) Vendor is a BOCC consultant? Yes❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 07/01/15 Approved by Board Yes® No[:] Agenda Date: This agreement is approved as to technical form @ft�t Xrjed by: N. �y C0,40A Department Director's Signature 9.4E E-146A@8B4b5 Date: 6/29/2015 Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of ins T7EeF;917a800,t dig;&I ys'peecifications,and requirements: r,6Vlit b 6/29/2015 Office of the Risk Management Officer Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: �MAL to D""`bvu 7/6/2015 Office of the Chief Financial Officer 232ni Date: Legal Services This agreement is approved as to legal form and J�,ffl,,Siq,ned by: Office of the County Attorney Date: 7/6/2015 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollo dnoran ecount nc, ov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: