HomeMy WebLinkAboutR 2015-542-E Health - Piedmont Health Services, Inc. for Komen Grant Data Support Services DocuSign Envelope ID: D17CCEEF-218F-4ADB-9723-17425A2F92A9
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
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: $2,300.00 Purpose: Komen Grant Data Support Services Budget Code(s): 30414020-680019-71132 Vendor
4 27868 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ❑
Renewal® Amendment ❑ Effective Date 4/1/15 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved a to to E�Y°ft%Y did c�oAnteent-
��"Q ' 9/24/2015
Department Director's Signature CAF IIfl1DFCRR5dFE___ 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 sufficient p �-,�''""�,�.''sttandards,specifications,and requirements:
Q�So, r,6vvt,e b 9/29/2015
Office of the Risk Management Office Date:
Financial Services
This instrument has been pre-audited i e�i�e�'uired by the Local Government Budget and Fiscal Control Act:
�AU� �6vu 9/30/2015
Office of the Chief Financial Officer z3z�ECZCFA847R_ Date:
Legal Services
This agreement is approved as to 6wmetm0 sufficiency:
Office of the County Attorneys Date: 10/5/2015
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 10/14 5