Orange County NC Website
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: (919) <br /> 913-1097 Party/Vendor Address: PO Box 17179 City Chapel Hill State: NC Zip: 27516 Department: HEALTH Amount: <br /> Purpose: Komen Grant Support Agreement Amendment to contract 2016-337-E Budget Code(s): 30414020-680019-71132 <br /> Vendor#27868 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ❑ <br /> Renewal❑ Amendment ® Effective Date 4/1/17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to 9 PPff content: <br /> bV0 7/11/2017 <br /> Department Director's Signature 5145A7C11945f14OF Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficienc q �s %'s'taandards,specifications, and requirements: <br /> attSa. Corr .c,ltb 7/18/2017 <br /> Office of the Risk Management Officer 7FM-F91758O049R Date: <br /> Financial Services <br /> This instrument has been pre-audited i ePffalifirt Yiequired by the Local Government Budget and Fiscal Control Act: <br /> el a9tiy ArbitilaosL 7/18/2017 <br /> Office of the Chief Financial Officer 7P4F51R1ACC1409 Date: <br /> Legal Services <br /> This agreement is approved as t e Rr 1�4f'a 1'd Buff ciency: <br /> ff 'f' f' -Sfa 7/18/2017 <br /> Office of the County Attorney 079A4D52SCOF4FB... 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 July 2015 <br />