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DocuSign Envelope ID:BE949AA1-4694-4E6D-9DBA-90D729491FE0 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Piedmont Health Services,Inc. Party/Vendor Contact Person: Jen Cunningham Contact Phone: <br /> (919) 913-1097 Party/Vendor Address: PO Box 17179 City Chapel Hill State: NC Zip: 27516 Department: Health <br /> Amount: $2,304 Purpose: 1(omen Grant Data Support Services Budget Code(s): 30414020-680019-71132 Vendor# <br /> 27868 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ❑ <br /> Renewal® Amendment ❑ Effective Date 4/1/15 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to nier ti hd content: <br /> 6_,,te_ 7/6/2016 <br /> Department Director's Signature CaEcennF;6R54gF Date: <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 sufficien gtiliaMrstandards,specifications,and requirements: <br /> MSA rbY1A,'ta b 7/6/2016 <br /> Office of the Risk Management Office 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited i t eD �i1 P quired by the Local Government Budget and Fiscal Control Act: <br /> ��� Date: 7/6/2016 <br /> Office of the Chief Financial Officer 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to ef1R1t1eflttl sufficiency: <br /> 7/6/2016 <br /> Office of the County Attorney 4035C88304CA4A9 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 /> Revised 6/16 4 <br />