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<br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: UNC School of Dentistry Party/Vendor Contact Person: Martha Barbour Contact Phone: <br /> 919-537-3570 Party/Vendor Address: CB #7450 City Chapel Hill State: NC Zip: 27599 Department: Health <br /> Amount: $58,445 Purpose: Resident dental services Budget Code(s): 10410120-630000 Vendor#36302 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal <br /> Amendment ❑ Effective Date 7/1/15 Approved by Board Yes[]No❑ Agenda Date: <br /> This agreement is approved as to technical fprm and content: <br /> Department Director's Signature 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 sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer_: Date:l� <br /> Financial Services <br /> This instrument has been pre-audited in the er require by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> 1 <br /> This agreement is approved as to legs and ffi 'ency: <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync•g_o_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 />