HomeMy WebLinkAboutR 2015-352-E Health - Cynthia Gamble, DSS, for dental services DocuSign Envelope ID: C8392BCC-AAA2-4C70-99A2-3BOA53622CD4
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: CYNTHIA GAMBLE,DDS Party/Vendor Contact Person: CYNTHIA GAMBLE Contact Phone:
919-380-1042 Party/Vendor Address: 114 OAKMIST DR. City CARY State: NC Zip: 27513 Department: HEALTH
Amount: $11.200 Purpose: DENTAL SERVICES Budget Code(s): 10410120-630000 Vendor 4 59544 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ❑ Renewal ® Amendment
❑ Effective Date 7/1/2015 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to tr�Docusigned 1%4r b,�:
°Department Director's Signatur Date: 7/23/2015
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Information Technolouies
(Applicable only to ha7rdwa7re/sofhva7re 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 sufficienc, -'W' o usigned by '- '-'ds, specifications, and requirements:
Office of the Risk Management Officer (h1 6 Date: 7/23/2015
7FDCF9176800498...
Financial Services
This instrument has been pre-audited i Dacusigned by: )y the Local Government Budget and Fiscal Control Act:
P �6� 7/23/2015
Office of the Chief Financial Officer 282DFFC2CFA8476 Date:
Leual Services
This agreement is approved as t� Docusigned by: ncy:
Office of the County Attorney � 35CB8'; 4CA4__ Date: 7/24/2015
4�35C68304CA4A�...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dgilsr dsrrreesrunt ry
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Rev. 7/15 8