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ORANGE COUNTY-DEPARTMENT USE ONLY 7 0,y� <br /> Deepa m nt ` / <br /> Party/Vendor Name: UNC Health Care System Party/Vendor Contact Person: Kathryn Grant Contact Phone:984- <br /> 974-1274 Party/Vendor Address: 211 Friday Center Drive City Chanel Hill State: NC Zip: 27517 Department: <br /> Health Amount: $39,462 Purpose: Komen Grant Breast Cancer Screening- Services Budget Code(s): 30412005- <br /> 443057-71132 Vendor# 51843 Rem.6 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® <br /> Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 4/1/16 Approved by Board <br /> Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technic a fo and content: ` <br /> Department Director's Signature "::, Date:.c <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�st/andards,specifications,and requirements: <br /> Office of the Risk Management Officer__ A,— AV Date: <br /> Financial Services <br /> This instrument has been pre-audited in the m ere it d by e Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer. Date: Z S <br /> Legal Services <br /> This agreement is approved as to legal fo suffic y <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon co letion @ Dollo}d((aoran eg countync.gov <br /> The following signature block is for hard copies o is no equired for Docusign contracts: <br /> Office of the Clerk to the Board Date:3 <br /> { SV60CX} <br /> 9 <br />