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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> �arty/Vendor Name: UNC School of Dentistry Party/Vendor Contact Person: Shayna Hill Contact Phone: 919- <br /> 37-3574 Party/Vendor Address:CB#7450 City Chapel Hill S te:NC Zip:27599 Department: Health Amount: <br /> 5 <br /> Crvendor)60 403 Purpose: Resident dental services Budget Code(s 0410120-630000 Vendor # 36302 (N/A if new <br /> Vendor is a BOCC consultant? Yes ❑ No® ontract Type: (Check one) New ❑ Renewal <br /> Amendment ❑ Effective Date 7/1/16 Approved by Board es❑No❑ Agenda Date: <br /> This agreement is approved as to technical Prm and content: <br /> Department Director's Signature 2 Date: /,,?,;�7—/, <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 L�L_ j &_Vzz_ Date: l � / (p <br /> Financial Services <br /> This instrument has been pre-audited in them r requi by t Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 7- / <br /> Le�a1 Services <br /> This agreement is approved as to legal form ufficiency: <br /> Office of the County Attorney Date: 1 L+ <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloy pon completion @ Dolloydgorangecountync.gov <br /> The following signature block is for hard y n is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: 1 111//7 <br /> Rev. 6/16 <br />