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2015-557 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY l <br /> Department <br /> Party/Vendor Name: UNC Department of Family Medicin Party/Vendor Contact Person: Pam Hoover <br /> Contact Phone: 919-966-3907 Party/Vendor Address: 590 Manning Drive City Chapel Hill State:NC Zip:27599 <br /> Department: Health Amount: $145,416 Purpose: Medical Director Services Budget Code(s): 10414020-630000- <br /> 71400/71403/71406/71409/71414/71416 Vendor#21243 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7-1-15 <br /> Approved by Board Yes[]Non Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: s <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 sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer 1/ Date: /61,- Z h j <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: � <br /> Office of the Chief Financial Officer I ! QI M Date:AD <br /> G <br /> Legal Services <br /> This agreement is approved as to lega f d s cy: <br /> Office of the County Attorney Date: 1 0 L� <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydaa,oran eg count cc og_v <br /> The following signature block is for hard c 'es o d is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: to <br /> 12 <br />