2022-139-E-Health-UNC School of Dentistry-Resident dental services

Browse Search

DocuSign Envelope ID:8E934AAF-CB04-4BC8-BE84-47915389317B ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: UNC School of Dentistry Party/Vendor Contact Person: Jessi Hill Contact Phone: 919-537- 3513 Party/Vendor Address: CB #7450, 467 Brauer Hall City Chapel Hill State: NC Zip: 27599 Department: Health Amount: $68,554.92 Purpose: Resident dental services Budget Code(s): 10410020-630000 Vendor # 36302 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date 7-1-21 Approved by Board Yes❑ No❑ Agenda Date: --- For Section XIV.c.contracts only,Approved by Board in Current FY Budget Yes®No❑ This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated riof T Mionof�'the agreement: �Y k A.In.A. skwof 3/24/2022 Department Director's Signature ,,,rF9DQAF 4ArF Date: Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Waiting on contract to go through UNC legal. Started process in April 2021,received signed copy March 24,2022.UNC had turn over and other issues getting me signed copy. Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency-of NsMna'ftta�ndards,specifications,and requirements: QUS& C,bV1nt{�b 3/29/2022 Office of the Risk Management Officer ,FDCFa„saooaAa Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: �� +� � 3/30/2022 Office of the Chief Financial Officer ,naFs,a,acc,an9 Date: Legal Services This agreement is approved as tcr7 9�4Mqvrftd sufficiency: a kuk L Tmo 3/30/2022 Office of the County Attorney Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 06/21