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ORANGE COUNTY - -- DEPARTMENT USE ONLY -- -HARD COPY ONLY <br />Department <br />Party/Vendor Name: UNC Hospitals Party /Vendor Contact Person: Tom Maltais Contact Phone: <br />Party /Vendor Address: Hedrick Bldg., Ste 1069 City Cha ep 1 Hill State: NC Zip: 27517 De artment: Aging <br />Amount: $25,000 Purpose: Wellness Coordinator Support Budget Code(s): 29430305- 499999 dor # 30892- <br />(N /A if new vendor) Vendor is a BOCC consultant. Yes ❑ No[] Contract Type: (Che ne) New ❑ l <br />Renewal ® Amendment ❑ Effective Date 7/01/1-1 Approved by Board Yes❑ No❑ Agenda Date: <br />This agreement is approved as to technical form and content: <br />Department Director's Signature ` E4GC mot. Date:.5-�� <br />Information TechnololZies <br />(Applicable only to hardlvare /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 <br />Risk Management <br />Date: <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of Risk Management Date: <br />Financiat Se ices <br />This instrument has been pre- audited in the in err u' y the Local Government Budget and Fiscal Control <br />Act: <br />Office of the Chief Financial Officer Date: 7 ! p <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney c,dUA t/4& Oyy� Date: W a-1 11% <br />Clerk to the Board <br />Received for record retention: <br />Office of the Clerk to the Board Date: <br />Revised 10/17 <br />