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UNC SOM #18-0743.t006 <br />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 />Franklin Farmer Contact Phone:919.937.3757 Party/Vendor Address: 170 Manning Drive City Chapel <br />Hill State: NC Zip: 27599 Department: Department of Emergency Medicine Amount: $70,200 Purpose: <br />EMS Medical Director's Contract Budget Code(s): 10- 7575206300 Vendor # N/A (N/A if new vendor) <br />Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal <br />Amendment Effective Date July 1, 2022 Approved 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 th e 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 /> <br />Clerk to the Board <br /> <br />Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: <br />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: 698648CF-624D-412B-BA7B-E91CEAED21DEDocuSign Envelope ID: B3162434-5D97-4AAC-BFF5-618BB52CB638 <br />10/18/2022 <br />10/19/2022 <br />10/19/2022 <br />11/7/2022