R 2015-535-E Health - Piedmont Health Services, Inc. - 2015-16 Outside Agency Performance Agreement

Browse Search

DocuSign Envelope ID: B8F76F11-8DOD-43D5-8654-06F0031808EC ORANGE COUNTY-DEPARTMENT USE ONLY Deuartment Party/Vendor Name: Piedmont Health Services,Inc Party/Vendor Contact Person: Jen Cunningham Contact Phone: (919) 913-1097 Party/Vendor Address: PO Box 17179 City Chapel Hill State: NC Zip: 27516 Department: Health Amount: $10,000 Purpose: Budget Code(s): 10414020-630000 Vendor 4 27898 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/15 Approved by Board Yes®No❑ Agenda Date: 6/16/15 This agreement is approved as tot p' &1 �axnd ontent: (�D� 9/24/2015 Department Director's Signatur Date: 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 sufficienc nFBC-F9+7&&6 a�u� e,standards,specifications,and requirements: sa, (hm,&b 9/29/2015 Office of the Risk Management Officer � Da te: Financial Services This instrument has been pre-audited i ip Fi �equired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Office eFFEZC-F,aaet ... Date: 10/4/2015 Legal Services This agreement is approved as t egRFT6i4ffMffl sufficiency: 44j11�, 10/5/2015 Office of the County Attorney aT�sC'.P- oaoa Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Piedmont Health Services,Inc. Orange County Performance Agreement Page 7