R 2017-271-E Health - Family Centered Healthcare, PA to provide primary care for uninsured males in OC

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DocuSign Envelope ID:AEED3652-BFF0-4DF2-B647-E07D63C5C5E4 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Family Centered Healthcare,PA Party/Vendor Contact Person: Anissa Vines Contact Phone: 919-245-3247 Party/Vendor Address: 400 Millstone Drive, Suite 100 City Hillsborough State: NC Zip: 27278 Department: Health Amount: $10,000 Purpose: Provide Primary Care for uninsured males of Orange County Budget Code(s): 10414020-630000-71422 Vendor#63536 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7-1-17 Approved by Board Yes No Agenda Date: This agreement is approved as to to ni P$ d content: Vat l�l�l 7/4/2017 Department Director's Signature 5145A2CD945C40F... Date: Information Technologies (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 sufficienc q 4Pfsilicit19''"�ys'taandards,specifications, and requirements: QtISa. C,bV'I�tL{�b 7/5/2017 Office of the Risk Management Officer 7FDCF9176800498... Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: ` °" a..x. 7/5/2017 Office of the Chief Financial Officer 7D4E5181ACC1409... Date: Legal Services This agreement is approved as t , �yy tAAAA, _ 1' -)SG6 7/5/2017 Office of the County Attorney 079A4D525C0F4FB... Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.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: