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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: UNC at Chapel Hill Party/Vendor Contact Person: Lisa Pe rry Contact Phone: 919-966-5982 <br /> Party/Vendor Address:CB7445,401 B Rosenau Hall City Chapel Hill State:NC Zip:27599-7445 Department:Health Amount: <br /> $19,025.57 Purpose: Interim Health Director Budget Code(s): 10410020-630000 Vendor # 10419 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal ❑ Amendment ® Effective <br /> Date 8-24-17 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature A Date: { J <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 sufficiency of insurance standards,specifications,and requirements: <br /> Office of Risk Management ( `� — Date: j(Z4.7 <br /> Financial Services <br /> This instrument has been pre-audited in the ne r qu red the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date: Z t 7 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney 4.41tf lua, kit' Date: `)ka I/I l <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: 1 <br /> Revised June 2017 <br />