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DocuSign Envelope ID: 314390E1-681E-443D-93AA-18AFB7BE38D8 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: PIEDMONT HEALTH SERVICES Party/Vendor Contact Person: LYNELL HODGES <br /> Contact Phone: 919-942-8741 x1482 Party/Vendor Address: PO BOX 17179 City CHAPEL HILL State: NC <br /> Zip: 27516 Department: HEALTH Amount: $33,000 Purpose: DIETITIAN Budget Code(s): Vendor 4 <br /> 27898 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New ❑ <br /> Renewal❑ Amendment ❑ Effective Date Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to to Wnd content: <br /> b� 8/6/2015 <br /> Department Director's Signature �eaBO��e Date: <br /> Information 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 Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient Dia,%iiaa Q,:standards,specifications,and requirements: <br /> ��FBC-H-1-7&H iSa / <br /> � 8 6/2015 <br /> Office of the Risk Management Office oa Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer vu Date: 8/11/2015 <br /> Legal Services <br /> This agreement is approved as t Rtgltfg l sufficiency: <br /> L 44�j 1�� <br /> Office of the County Attorneys Date: 8/11/2015 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v <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 /> Revised July 2015 <br /> 8 <br />