R 2017-515-E Health - NC Public Health Association for smoking cessation coaching

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DocuSign Envelope ID:4C3F4116-538F-4051-AC16-B880C7C5E276 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: North Carolina Public Health Association Party/Vendor Contact Person: Lynette Tolson Contact Phone: 919-828-6201 Party/Vendor Address: 222 N. Person Street, Suite 208 City Raleigh State: NC Zip: 27601 Department: Health Amount: $5,000 Purpose: Smoking cessation coaching Budget Code(s): 10412020-680070-71454 Vendor# 50866 (N/A if new vendor) Vendor is a BOCC consultant'? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 10-4-17 Approved by Board Yes No Agenda Date: This agreement is approved as to tectin 1�f�id d��c�on1n�tent: bro 1,.u1Tt 9/13/2017 Department Director's Signature —5145A2cO 45c49F 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 Eittalsratuseystandards, specifications, and requirements: aMtSA. rbvvutl6 9/13/2017 Office of the Risk Management Officer -T 9498 Date: Financial Services This instrument has been pre-audited i t eD i P P quired by the Local Government Budget and Fiscal Control Act: �°" .0°"D 9/13/2017 Office of the Chief Financial Officer 7D4E5181ACC1409... Date: Legal Services This agreement is approved as tr, '-... Oitivicidavid sufficiency: I AA. hark- 1 sc.b 9/13/2017 Office of the County Attorney Date: o € DSZSeararc.._ 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: Revised 2/17 5