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2021-337-Health-MedAssist of Mecklenburg-Medassist to donate to Orange County EMS and Health dept
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2021-337-Health-MedAssist of Mecklenburg-Medassist to donate to Orange County EMS and Health dept
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7/2/2021 4:12:37 PM
Creation date
7/2/2021 4:12:35 PM
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Contract
Date
6/28/2021
Contract Starting Date
6/28/2021
Contract Ending Date
6/29/2021
Contract Document Type
Contract
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Revised 07/20 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: MedAssist of Mecklenburg Party/Vendor Contact Person: Kinzie Luce Contact Phone: 866- <br />331-1348 Party/Vendor Address: 4428 Taggart Creek Rd., Suite 101 City Charlotte State: NC Zip: 28208 <br />Department: Health Amount: $0 Purpose: MedAssist to donate to Orange County EMS and Health Departments <br />OTC medication. Budget Code(s): N/A Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes <br /> No Contract Type: (Check one) New Renewal Amendment Effective Date Approved by <br />Board Yes No Agenda Date: <br /> <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 /> <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br />Agreements for emergency services or repair are not subject to the above 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: <br /> <br />Information Technologies <br /> <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 /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: 334D2FB9-80AC-4BD8-A50F-0F81F20B370F <br />6/28/2021 <br />6/28/2021 <br />6/29/2021 <br />6/29/2021
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