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Revised 04/23 <br />1 <br />ORANGE COUNTY—INTERNAL USE ONLY <br />______________________________________________________________________________ <br />Finance Information <br />Vendor Name: University of North Carolina Hospitals Vendor Contact Person: Daryl Sams Phone: 984-974-0935 <br />Address: 500 Eastowne Drive, 2nd Floor City Chapel Hill State: NC Zip: 27514 Department: Social Services <br />Amount: $180,000 Purpose: Medicaid processing at UNCH Budget Code(s): 10403005-442311 Vendor # N/A <br />Vendor Status with NCSOS: N/A Vendor is a BOCC consultant: Yes No <br /> <br />Contract Details <br />Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) <br />Effective Date 7/1/21 End Date 6/30/25 Notice Date (Notice Purpose ) <br /> <br />Award <br /> Approved by Board (Agenda Date: ); Made or Administered by Nancy Coston <br /> <br />Signature Authority <br />- BOCC Express Delegation (Agenda Date: ) <br />- Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 <br />- Budget Policy Section XV (Capital Improvement Project: ) <br /> <br />Bidding <br /> Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# ) <br />Department Affirmation <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 /> Services related to this agreement have already begun or been completed. Description of the nature of the <br />emergency condition that was addressed: delayed contract <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br />Information Technologies <br />This agreement has been reviewed and is approved as to information technology content and specifications: <br /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> Inapplicable because no hardware/software purchases or related services <br /> <br />Risk Management <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 />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 />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 />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 />Received for record retention: <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: B4077D37-68C5-4E1B-808E-C88A9499D4DE <br />1/11/2024 <br />1/11/2024 <br />1/16/2024 <br />1/16/2024