R 2016-337-E Health - Piedmont Health Services, Inc. for Komen Grant Data Support Services

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DocuSign Envelope ID:61B96AFO-9902-4072-B6BO-7716FB6AEOD3 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Piedmont Health Services,Inc. Party/Vendor Contact Person: Jen Cunningham Contact Phone: (919) 913-1097 Party/Vendor Address: PO Box 17179 City Chapel Hill State: NC Zip: 27516 Department: Health Amount: $2,304 Purpose: Komen Grant Data Support Services Budget Code(s): 30414020-680019-71132 Vendor# 27868 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal® Amendment ❑ Effective Date 411115 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to to mEa4�%d content: � '°�� 7/6/2016 Department Director's Signature r".. nnGCFasnsG Date: Information Technologies (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 sufficien MVP tft,:standards,specifications,and requirements: a�Sa rbvvutl6 7/6/2016 Office of the Risk Management Office 7FD,F9176800498... Date. Financial Services This instrument has been pre-audited i t e"IfflO W�6:quired by the Local Government Budget and Fiscal Control Act: Date: 7/6/2016 Office of the Chief Financial Officer Lj-t-A 4E5181ACC1409... Legal Services This agreement is approved as to e sufficiency: Office of the County Attorney Date: 7/6/2016 Clerk to the Board Received for record retention All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync.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