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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLYa <br /> Department <br /> Party/Vendor Name: UNC Hospitals Party/Vendor Contact Person: Susan Blalock Contact Phone: <br /> Party/Vendor Address: 211 Friday Center Dr., Ste. G021 City Chapel Hill State: NC Zip: 27517 Department: <br /> Aging Amount: $25,000 Purpose: Wellness Program Coordinator Budget Code( • 7Check Vendor# � ' <br /> 30892 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No[—] Con pe: )NewRenewal ® Amendment ❑ Effective Date 07/01/2016 Approved by Board Yes Nonda Date: <br /> This agreement is approved as to technical form and content: 6 6� <br /> Department Director's Signature Date: j-A-/7 ' I <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 /> 1 _ <br /> Office of Risk Management 1it`6 - t Q Date:_ t <br /> F'nan ' rvice <br /> This instrument has been pre-audited in the er quir d b t e Local Government Budget and Fiscal Control <br /> Act: / <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: / <br /> Office of the County Attorney (/{(�il,� (/ �� 6th Date: `t 1 cl I�l <br /> r <br /> Clerk Ohe B and <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 2/17 <br />