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DocuSign Envelope ID:4C485144-3EA1-4A86-8777-0808354A83DE <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: NC PUBLIC HEALTH FOUNDATION Party/Vendor Contact Person: CHUCK BRIDGER Contact <br /> Phone: (980) 522-1621 Party/Vendor Address: PO BOX 18763 City RALIEGH State: NC Zip: 27619 Department: <br /> HEALTH Amount: $0.00 Purpose: QUIT LINE AMENDMENT Budget Code(s): Vendor # 56861 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ❑ Renewal❑ Amendment <br /> Effective Date 5/1/14 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to to 'c9ME tid ontent: <br /> 6,6&AAA, 15n '0 ' 12/18/2015 <br /> Department Director's Signature ceEDSOOFCSes4sE... Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficienc I worstandards,specifications,and requirements: <br /> QUSA, Cord..*& 12/19/2015 <br /> Office of the Risk Management Officer 7E1JGFg17680A498 Date: <br /> Financial Services <br /> This instrument has been pre-audited i by the Local Government Budget and Fiscal Control Act: <br /> ,„../.. z 12/20/2015 <br /> Office of the Chief Financial Officer Date: <br /> 7.mbuttuPequired <br /> 51�1�t,14b9... <br /> Legal Services <br /> This agreement is approved as toekgsloimmend sufficiency: <br /> Office of the County Attorney 4 �` Date: 12/21/2015 <br /> y 4033CB6004CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <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 />