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c <br /> ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: UNC at Chapel Hill Party/Vendor Contact Person: Kevin Castle Contact Phone: <br /> Party/Vendor Address: School of Medicine,Dept of Allied Health Sciences City Chapel Hill State:NC Zip:27599 <br /> Department: Aging Amount: $6,000 Purpose: physical function screens Budget Code(s): 29430320-630000 <br /> Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one) <br /> New ❑ Renewal ® Amendment ❑ Effective Date 7/01/2018 Approved by Board Yes❑No❑ Agenda <br /> Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: <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 Date: <br /> Financial Services <br /> This instrument has been pre-audited in the annLuired y the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: <br /> Leal Services <br /> This agreement is approved as to legal f r and sufficiency: <br /> Office of the County Attorney _ Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/17 <br />