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Revised 06/21 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: UNC School of Dentistry Party/Vendor Contact Person: Jessi Hill Contact Phone: 919-537- <br />3513 Party/Vendor Address: CB #7450, 467 Brauer Hall City Chapel Hill State: NC Zip: 27599 Department: <br />Health Amount: $68,554.92 Purpose: Resident dental services Budget Code(s): 10410020-630000 Vendor # <br />36302 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New <br />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 <br />on 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 <br />was addressed: Waiting on contract to go through UNC legal. Started process in April 2021, received signed copy <br />March 24, 2022. UNC had turn over and other issues getting me signed copy. <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 />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: 8E934AAF-CB04-4BC8-BE84-47915389317B <br />3/24/2022 <br />3/29/2022 <br />3/30/2022 <br />3/30/2022