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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <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: $167,2 17.50 Purpose:Medical Director and Mental Health Services Budget Code(s): <br /> 10414020-630000-71400/71403/71406/71409/71414/71416 Vendor#21243 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective <br /> Date 7-1-18 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to techn'cal form and content: <br /> Department Director's Signature v Date: 10-3 -1Y <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 Risk Management {�j�� Date:J 0 <br /> or <br /> Financial Services <br /> This instrument has been pre-audited in the in err q.it by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: A11114 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney tz& 7rriL Date: 10 1-11 ot01% <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/17 <br />