HomeMy WebLinkAboutR 2014-564 Aging - NC Department of Insurance for Senior Health Insurance Information program $3,340 ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: NC Department of Insurance Party/Vendor Contact Person: R. Van Braxton Contact Phone:
919-807-6900 Party/Vendor Address: SHIM Division, 11 S.Boylan Ave. City Raleigh State: NC Zip: 27603
Department: Aging Amount: $3,340 Purpose: Senior Health Insurance Information Program Budget Code(s):
10432005444104 Vendor# 173 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract
Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/2014 Approved by Board Yes[:]
Nor-1 Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature Date:
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 a ement f�
This agreement is approved for sufficiency of insurance standards,specifications,and requirement U
Office of the Risk Management Officer Date: FNOV U 2014
By
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer C �• Date: �4 L
Legal Services
This agreement is approved as to lega and sufficiency:
Office of the County Attorney Date: 1 �'
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd(dWan eg coun nc.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: