HomeMy WebLinkAboutR 2015-535-E Health - Piedmont Health Services, Inc. - 2015-16 Outside Agency Performance Agreement DocuSign Envelope ID: B8F76F11-8DOD-43D5-8654-06F0031808EC
ORANGE COUNTY-DEPARTMENT USE ONLY
Deuartment
Party/Vendor Name: Piedmont Health Services,Inc Party/Vendor Contact Person: Jen Cunningham Contact Phone: (919)
913-1097 Party/Vendor Address: PO Box 17179 City Chapel Hill State: NC Zip: 27516 Department: Health Amount:
$10,000 Purpose: Budget Code(s): 10414020-630000 Vendor 4 27898 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/15
Approved by Board Yes®No❑ Agenda Date: 6/16/15
This agreement is approved as tot p' &1 �axnd ontent:
(�D� 9/24/2015
Department Director's Signatur 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 Management
This agreement is approved for sufficienc nFBC-F9+7&&6 a�u� e,standards,specifications,and requirements:
sa, (hm,&b 9/29/2015
Office of the Risk Management Officer � Da te:
Financial Services
This instrument has been pre-audited i ip Fi �equired by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Office eFFEZC-F,aaet ... Date: 10/4/2015
Legal Services
This agreement is approved as t egRFT6i4ffMffl sufficiency:
44j11�, 10/5/2015
Office of the County Attorney aT�sC'.P- oaoa 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:
Piedmont Health Services,Inc.
Orange County Performance Agreement
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