R 2015-542-E Health - Piedmont Health Services, Inc. for Komen Grant Data Support Services

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DocuSign Envelope ID: D17CCEEF-218F-4ADB-9723-17425A2F92A9 ORANGE COUNTY—DEPARTMENT USE ONLY Department 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: $2,300.00 Purpose: Komen Grant Data Support Services Budget Code(s): 30414020-680019-71132 Vendor 4 27868 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal® Amendment ❑ Effective Date 4/1/15 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved a to to E�Y°ft%Y did c�oAnteent- ��"Q ' 9/24/2015 Department Director's Signature CAF IIfl1DFCRR5dFE___ 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 sufficient p �-,�''""�,�.''sttandards,specifications,and requirements: Q�So, r,6vvt,e b 9/29/2015 Office of the Risk Management Office Date: Financial Services This instrument has been pre-audited i e�i�e�'uired by the Local Government Budget and Fiscal Control Act: �AU� �6vu 9/30/2015 Office of the Chief Financial Officer z3z�ECZCFA847R_ Date: Legal Services This agreement is approved as to 6wmetm0 sufficiency: Office of the County Attorneys Date: 10/5/2015 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: Revised 10/14 5