R 2018-564 DSS - UNC Hospital medicaid processing

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DocuSign Envelope ID:57E2C492-6A9C-4912-l33A2-0E01 EDD5857C ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: UNCH PartyNendor Contact Person: Danielle Reese Contact Phone: (984) 974- 2779 Party/Vendor Address: 800 Eastowne Drive,Suite 200. City Chapel Hill State: NC Zip:27514 Department: Social Services Amount: $41,021 Purpose: Medicaid Processing at UNCH Budget Code(s): 10403005-442311 Vendor#NA (N/A if new vendor) Vendor is a BOCC consultant? Yes❑ NoE Contract Type: (Check one) New❑ RenewaI ® Amendment ❑ Effective Date July 1.2018 Approved by Board Yes❑NloZ Agenda Date: This agreement is approved as to to oocusigned by: tent: N �,bS m& 9/12/2018 Department Director's Signature oAE9E1s6A83B455... Date: Information Technologies (Applicable only to hardwarelsofhvare purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficient 'W* cuSigned by:' .ds,specifications,and requirements: ,USX ( Q�6 8/10/2018 Office of the Risk Management Officer Date: - 7F6CF917E80Q498... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: Office of the Chief Financial Officer 4 ns... _Date: 9/12/2018 7NE5181ACC14 — Legal Services This agreement is approved as t C OocuSigned by: i7Cy: Office of the County Attorney � ' - Date: 9/13/2018 4035C68304CA4M... - - Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion Dolloyd@orangecountync.goy The following signature block is for hard copies only and is not required for Docusign contracts: