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2021-516-E-Health-Chatham County Public Health Department-Replication of CHG voucher program
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2021-516-E-Health-Chatham County Public Health Department-Replication of CHG voucher program
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Last modified
9/22/2021 9:51:29 AM
Creation date
9/22/2021 9:51:25 AM
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Contract
Date
9/21/2021
Contract Starting Date
9/21/2021
Contract Ending Date
9/21/2021
Contract Document Type
Contract
Amount
$1,050.00
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Revised 06/21 <br /> <br /> <br />4 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Chatham County Public Health Department Party/Vendor Contact Person: Laura Hearn <br />Contact Phone: Party/Vendor Address: 1000 S. 10th Ave. City Siler City State: NC Zip: 27344 Department: <br />Health Amount: $1,050 Purpose: Replication of CHG voucher program Budget Code(s): 10414020-680007-71424 <br />Vendor # 51966 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) <br />New Renewal Amendment Effective Date 7-1-21 Approved by Board Yes No Agenda Date: - <br />-- For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes No <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br />this project has not been initiated prior to execution of the agreement: <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 was <br />addressed: Did not receive contract from State until mid-August (had notice in June). Needed to go before the board <br />and for the budget to be uploaded to Munis. <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 technolo gy 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 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: <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 /> <br />DocuSign Envelope ID: 5F0C03C2-6AC8-4A97-B63B-607AD2071602 <br />9/21/2021 <br />9/21/2021 <br />9/21/2021 <br />9/21/2021
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