R 2016-325-E Health - The North Carolina Public Health Foundation for smoking cessation counseling

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DocuSign Envelope ID:91F43AFA-8CB4-4861-887A-F304C7A6614B ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: The North Carolina Public Health Foundation Party/Vendor Contact Person: Chuck Bridger Contact Phone: 980-522-1621 Party/Vendor Address: PO Box 18763 City Raleigh State: NC Zip: 27619 Department: Health Amount: $5,000 Purpose: Smoking Cessation Counseling Budget Code(s): 10412020-680070- 71454 Vendor# 56861 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7-1-16 Approved by Board Yes❑ No❑ Agenda Date: This agreement is approved as to to n %PMWhd content: f,,._ E-6- 6/23/2016 Department Director's Signature C9EO9Q0FC6B545E_ Date: Information Technolosies (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 sufficiency-of/ma&mmaeystandards, specifications,and requirements: QUSA. r,Orv�,c,�16 6/24/2016 Office of the Risk Management Officer �sF hntt Date: Financial Services This instrument has been pre-audited in e q�u ed by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer Li4E5181ACC1409... Date: 6/27/2016 Legal Services This agreement is approved as t eg°a4`l'b"'ffifd sufficiency: Office of the County Attorney a�,��,RR��a�,oaoa Date: 6/27/2016 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.gov 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 6/16 4