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0 <br />C;�20 lg <br />ORANGE COUNTY-DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: UNC School of Medicine - Department of Psychiatry Party/Vendor Contact Person: Karlina <br />Matthews, Associate Chair for Administration Contact Phone: 919 -960 -1291 Party/Vendor Address: 378 Medical / <br />School Wing D, CB# 7160 City Chapel Hill State: NC Zip: 27599 -7160 Depa nt: CJRD Amount: $25,000 V <br />Purpose: contract psychiatry Budget Code(s): 10212020-630000 (PO 1802270 -0 dor # 49882 (N /A if newq I ('3119 <br />vendor) Vendor is a BOCC consultant? Yes ❑ NoN Contract Type: (Che one) New N Renewal ❑ <br />Amendment ❑ Effective Date 6/10/18 Approved by Board Yes❑ No❑ Agenda Date: <br />This agreement is approved as to technical form and content: <br />Department Director's Signature Date: 7 & ty' <br />Information Technologies <br />(Applicable only to hardware /sgfhvare 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 the Risk Management Officer, Date: 1 <br />This instrument has been pre - audited <br />Act: <br />Office of the Chief Financial Officer <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />ment Budget and Fiscal Control <br />Date: / IL 9 <br />Office of the County Attorney Date: 4 /� <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll oran ecountync,gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br />Office of the Cleric to the Board Date: <br />Revised 10/17 <br />