Orange County NC Website
Browse       Search
DocuSign Envelope ID: 1D03195F-09B6-4CDF-BCE2-75BE4FF7B2FF <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: M. MONICA MENG-HAGGERTY, DDS Party/Vendor Contact Person: M. MONICA MENG- <br /> HAGGERTY Contact Phone: 919-816-6493 Party/Vendor Address: 215 BLUEFIELD RD. City CHAPEL HILL State: <br /> NC Zip: 27517 Department: HEALTH Amount: $11.200 Purpose: DENTAL SERVICES Budget Code(s): 10410120- <br /> 630000 Vendor 4 62571 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check <br /> one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/2015 Approved by Board Yes❑ No❑ Agenda <br /> Date: <br /> This agreement is approved as to te, Doctus5gnea by: <br /> Department Director's Signature Date: 7/23/2015 <br /> CQED9DOFCEB545E.... <br /> Information Technolouies <br /> (Applicable only to ha7rdwa7re/sofhva7re purchases or related services)This agreement has been reviewed and is approved <br /> as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficienc, -rwousi fgnea by: -ds, specifications, and requirements: <br /> �u��` �-^'�'�'� 7/24/2015 <br /> Office Of the Risk Management Officer 7FDCF917680040E... Date: <br /> Financial Services <br /> This instrument has been pre-audited i� DoG usigned by: )y the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date:PaU 61vu 7/24/2015 <br /> 232DFFC2CFA847B... <br /> Leual Services <br /> This agreement is approved as t oocusigned by: ncy: <br /> fir <br /> Office of the County Attorney ,mnh__ Date: 7/24/2015 <br /> 4035CB8304CA4M... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dgilsr dsrrreesrunt ry <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Rev. 7/15 8 <br />