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F6 ' <br /> ORANGE COUNTY--DEPARTMENT USE ONLY-HARD COPY ONLY j <br /> Department <br /> Party/Vendor Name: UNC Health Care System Party/Vendor Contact Person: Kathrw Grant Contact Phone: 984- <br /> 974-1274 Party/Vendor Address: 211 Friday Center Drive City Chanel Hill State: NC Zip: 27517 Department: <br /> Health Amount: $14,000 Purpose: BCCCP Mammogram Screenings Budget Code(s): 10414020-631010-71401 <br /> Vendor p 30892 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) <br /> New ❑ Renewal ® Amendment ❑ Effective Date 7-17-118 Approved by Board Yes❑ No❑ Agenda Date: <br /> This agreement is approved as to technical fQno and c tent: <br /> Department Director's Signature �llu"I WL� vs� Date: <br /> Information Technologies <br /> (Applicable only to hardware/sojhuare 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, said requirements: <br /> Office of Risk Management ! .t%t-�. r-Y 0" Dme/ B <br /> Financial Servi <br /> This instrument has been pre-audited in [hem ffmqd e Local Government Budge[ and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: a <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney (Z&u t,/it tut ze- (`'- Date: 101301 1'6 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 10117 <br />