HomeMy WebLinkAboutR 2015-396-E Health - NC Public Health Foundation - Amendment to Quit Line Services Agreement dated 5-1-2014 DocuSign Envelope ID: 7F8DFDB2-D81A-4AOF-AF96-9B69F601FC96
ORANGE COUNTY—DEPARTMENT USE ONLY
Deuartment
Party/Vendor Name: NC PUBLIC HEALTH FOUNDATION Party/Vendor Contact Person: CHUCK BRIDGER Contact
Phone: (980) 522-1621 Party/Vendor Address: PO BOX 18763 City RALIEGH State: NC Zip: 27619 Department:
HEALTH Amount: $0.00 Purpose: QUIT LINE AMENDMENT Budget Code(s): Vendor 4 56861 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑ Renewal ❑ Amendment
Effective Date 5/1/14 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to to ei�r1d content:
Department Director's Signatur Date: 8/4/2015
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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 sufficienc nFBC-F9+7&&6 rge„standards,specifications,and requirements:
sa, (hm,&b 8/4/2015
Office of the Risk Management Officer � Da te:
Financial Services
This instrument has been pre-audited i
r%_a exrrequired by the Local Government Budget and Fiscal Control Act:
,
Office of the Chief Financial Officer oF, Date: 8/4/2015
Legal Services
This agreement is approved as t �� fnd sufficiency:
Office of the County Attorne Date: 8/5/2015
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:
Revised July 2015