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7 <br />Rev. 6/17 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />________________________________________________________________________ <br />Department <br />Party/Vendor Name: University of North Carolina Party/Vendor Contact Person: Greg Godic Contact <br />Phone: 919-843-9480 Party/Vendor Address: UNC School of Medicine <br />3140 Bioinformatics Building <br /> City Chapel Hill, State: NC Zip: 27599 Department: Emergency Medicine Amount: $51,700 Purpose: <br /> Budget Code(s): 10-757520630000 Vendor # (N/A if new vendor) Vendor is a BOCC <br />consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective <br />Date Approved by Board Yes No Agenda Date: <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br />Information Technologies <br />(Applicable only to hardware/software purchases or related services) This agreement has been reviewed <br />and is 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___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal <br />Control Act: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________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 />DocuSign Envelope ID: 0420C055-135C-4A55-9126-6985B56EAC9C <br /><br /> <br /><br /> <br /><br /> <br /> <br />