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DocuSign Envelope ID: BA090480-FC7C-4753-AEF2-19BCB43C5FFB <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: UNC School of Medicine-Department of Psychiatry Party/Vendor Contact Person: Melisa <br /> Campbell, Interim Associate Chair of Administration Contact Phone: 919-843-6345 Party/Vendor Address: 372 <br /> Medical School Wing D CB # 7160 City Chapel Hit l State: NC Zip: 27599-7160 Department: CJRD Amount: <br /> $25,000 Purpose: contract psychiatry Budget Code(s): 10212020-630000 Vendor# 49882 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ <br /> Effective Date 7/1/19 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> P DocuSigned by: <br /> Department Director's Signature L 1W r� Date:2/27/2020 <br /> Agreements for emergency services or repair are 27❑7sESEFC51493... affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: N/A <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 /> DocuSigned by: <br /> Office of the Risk Management Officer aUS66 (,6�6 Date:212712020 <br /> 7FDCF9176900498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer ('1) Date:2/2 712020 <br /> 7NE5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiencv: <br /> DocuSigned by: <br /> Office of the County Attorney �6� K6k'6 Date:2/28/2020 <br /> EAMD33ED8AW5... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 11/19 <br /> 8 <br />