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2020-645-E Emergency Svc-UNC Hospitals medical director services
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2020-645-E Emergency Svc-UNC Hospitals medical director services
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7 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />________________________________________________________________________ <br /> <br />Party/Vendor Name: University of North Carolina- School of Medicine Party/Vendor Contact Person: <br />Alison M. Melvin Contact Phone: 919-966-4548 Party/Vendor Address: 3140 Bioinformatics Building <br />City Chapel Hill State: NC Zip: 27599 Department: Office of Professional Service Contracts and <br />Affiliations Amount: 51,700 Purpose: EMS Medical Director's Contract Budget Code(s): 10- <br />7575206300 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes No <br />Contract Type: (Check one) New Renewal Amendment Effective Date 07-01-2020 Approved <br />by Board Yes No Agenda Date: <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively <br />state work 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 <br />this agreement have already begun or been completed please briefly describe the nature of the emergency <br />condition that was addressed: <br /> <br />Information Technologies <br /> <br />(Applicable only to hardware/software purchases or related services) This agreement has been reviewed <br />and is 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 <br />Control 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 />Clerk to the Board <br /> <br />Received for record retention: All Docusign contracts must be copied to Sherri Ingersoll upon completion: <br />Singersoll@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: 86EFBE80-B26A-4B98-984D-32FF25A95668 <br />11/3/2020 <br />11/4/2020 <br />11/5/2020 <br />11/5/2020
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