R 2016-402-E Health - M. Monica Meng-Haggerty, DDS to provide dental services

Browse Search

DocuSign Envelope ID: BDC7A23B-OD7B-4786-8452-D97DA48C507E ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: M. MONICA MENG-HAGGERTY, DDS Party/Vendor Contact Person: M. MONICA MENG- HAGGERTY Contact Phone: 919-816-6493 Party/Vendor Address: 215 BLUEFIELD RD. City CHAPEL HILL State: NC Zip: 27517 Department: HEALTH Amount: $11.200 Purpose: DENTAL SERVICES Budget Code(s): 10410120- 630000 Vendor# 62571 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/2016 Approved by Board Yes❑ No❑ Agenda Date: This agreement is approved as to to In fbFWP Kd content: "— L--/y 7/23/2016 Department Director's Signature Date: Information Technolo0es (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 sufficiencyuf�!FDCF9176800498 11saigt�dN)Standards, specifications,and requirements: SA, (hVV,c,�16 7/25/2016 Office of the Risk Management Officer ... Date: Financial Services This instrument has been pre-audited i tmqTtyRfjrpjequircd by the Local Government Budget and Fiscal Control Act: 7/25/2016 Office of the Chief Financial Officer nnGS1�1P�G141 Date: Legal Services This agreement is approved as to�4035CE8304CA4A9 aP�ori anti sufficiency: 7/25/2016 Office of the County Attorney Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.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: Rev. 6/16 9