HomeMy WebLinkAboutR 2015-367-E Health -Diane Shugars to provide dental services DocuSign Envelope ID:244FE7D5-741 E-4623-A304-FEOBF8OB4E65
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: DIANE SHUGARS Party/Vendor Contact Person: DIANE SHUGARS Contact Phone: 919-967-
9251 Party/Vendor Address: 908 HIGHGROVE DR. City CHAPEL HILL State: NC Zip: 27516 Department:
HEALTH Amount: $5,600 Purpose: DENTAL SERVICES Budget Code(s): 10410120-630000 Vendor 4 56709 (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 to 15/p'va4- nnd content:
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Department Director's Signature Date: 7/23/2015
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 Management
This agreement is approved for sufficient 4 Vstandards,specifications,and requirements:
QUs& 66vvt,e 6 7/28/2015
Office of the Risk Management Officer mncpauranna p Date:
Financial Services
This instrument has been pre-audited i °��ri'��e�f wired by the Local Government Budget and Fiscal Control Act:
�A.U�, 7/28/2015
Office of the Chief Financial Officer �B� a ® Date:
Legal Services
This agreement is approved as t=44Q d sufficiency:
7/28/2015
Office of the County Attorney Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloyLyorangecou go v
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