HomeMy WebLinkAboutR 2015-353-E Health - M. Monica Meng-Haggerty, DDS, to provide dental services DocuSign Envelope ID: 1D03195F-09B6-4CDF-BCE2-75BE4FF7B2FF
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: M. MONICA MENG-HAGGERTY, DDS Party/Vendor Contact Person: M. MONICA MENG-
HAGGERTY Contact Phone: 919-816-6493 Party/Vendor Address: 215 BLUEFIELD RD. City CHAPEL HILL State:
NC Zip: 27517 Department: HEALTH Amount: $11.200 Purpose: DENTAL SERVICES Budget Code(s): 10410120-
630000 Vendor 4 62571 (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 te, Doctus5gnea by:
Department Director's Signature Date: 7/23/2015
CQED9DOFCEB545E....
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, -rwousi fgnea by: -ds, specifications, and requirements:
�u��` �-^'�'�'� 7/24/2015
Office Of the Risk Management Officer 7FDCF917680040E... Date:
Financial Services
This instrument has been pre-audited i� DoG usigned by: )y the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date:PaU 61vu 7/24/2015
232DFFC2CFA847B...
Leual Services
This agreement is approved as t oocusigned by: ncy:
fir
Office of the County Attorney ,mnh__ Date: 7/24/2015
4035CB8304CA4M...
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