Orange County NC Website
Browse       Search
ORANGE COUNTY—DEPARTMENT USE ONLY ,-� ,�I /_✓� <br /> Department <br /> Party/Vendor Name: UNC Department of Family Medicine Party/Vendor Contact Person: Pam Hoover Contact <br /> Phone: 919-966-3907 Party/Vendor Address: 590 Manning Drive City Chapel Hill State: NC Zip: 27599 <br /> Department: Health Amount: $157,000 Purpose: Medical Director Services Budget Code(s): 10414020-630000- <br /> 71400/71403/71406/71409/71414/71416 Vendor#21243 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7-1-17 <br /> Approved by Board Yes❑No❑ Agenda Date: ` <br /> 1� <br /> This agreement is approved as to technical form and content: / <br /> Department Director's Signature ( 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 sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer al. lJ Date:��z <br /> Financial Services <br /> This instrument has been pre-audited in the in er ed b the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: <br /> i-/J7 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney Irt r Date: I (/a2 0 V1 <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 pot requir d for Docusign contracts: ' <br /> Office of the Clerk to the Board Date: /7 <br /> 13 <br /> Rev 6/17 <br />