Orange County NC Website
DocuSign Envelope ID:31D3934C-CE6C-4B6A-A77D-A2C78EC2A7A3 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: M. Monica Meng-Haggerty, DDS Party/Vendor Contact Person: M. Monica Meng-Haggerty, <br /> DDS Contact Phone: 919-816-6493 Party/Vendor Address: 215 Bluefield Rd. City Chapel Hill State: NC Zip: 27517 <br /> Department: Health Amount: $11,200 Purpose: Dental Services Budget Code(s): 10410120-630000 Vendor# 62571 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No Contract Type: (Check one)New❑ Renewal <br /> Amendment ❑ Effective Date 7/1/2017 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to n 1lll�d ��d�content: <br /> bV0 t�VUt 7/5/2017 <br /> Department Director's Signature F14FG2r non,,r4rnF... Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved <br /> as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficient Lida.i,r neitystandards, specifications,and requirements: <br /> aMtSA. 6.61(W. 6 7/5/2017 <br /> Office of the Risk Management Office Date: <br /> $FOCronsBOOa9a... <br /> Financial Services <br /> This instrument has been pre-audited i cPtidiffiWitquired by the Local Government Budget and Fiscal Control Act: <br /> Aniiiio,ox. 7/5/2017 <br /> Office of the Chief Financial Officer znaFetatnco14o9 Date: <br /> Legal Services <br /> This agreement is approved as t e of f�4f`a3'd stiff ciency: <br /> ff 'f' f' -Sfa 7/6/2017 <br /> Office of the County Attorney o�9aa�szec0F4Fa... Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Rev. 6/16 8 <br />