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abl 6�a � <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: UNC Party/Vendor Contact Person: Ed Jackem Contact Phone: 919 843-2611 <br /> Party/Vendor Address: 170 Manning Dr. CB# 7594, City_ Chapel Hill State: _ NC Zip: <br /> 27599-7594 Department: Emergency Services Amount: 51,700 Purpose: Medical Director's <br /> Contract Budget Code(s): 10757520630000 Vendor#26130 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No® Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective <br /> Date July 1,2015 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form an content: T_ <br /> Department Director's Signature Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed <br /> and is 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 C' � -'—' Date: <br /> Financial Services <br /> This instrument has been pre-audited in the arequi e Loc al Government Budget and Fiscal <br /> Control Act: d <br /> Office of the Chief Financial Officer Date: 16 I C <br /> Leeal Services <br /> This agreement is approved as to legal and ciency: <br /> Office of the County Attorney Date: (o <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oranaecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> 7 <br />