HomeMy WebLinkAboutR 2015-622-E Aging - Orange County SHIIP contract - Senior health insurance information DocuSign Envelope ID: D37C6C9E-3CC6-4586-B782-34070527DC90
ORANGE COUNTY—DEPARTMENT USE ONLY
Department:
Party/Vendor Name: NC Depprtment of Insurance Party/Vendor Contact Person: R Van Braxton Contact Phone: <
919-807-6900 Party/Vendor Address: SHI1P Divislon, 1 1,5. Boylan Ave City Raleigh State: N.c. Lip: 27603
Department: Aging Amount: $42101 Purpose: Senior Health Insurance Information Program Budget Code(s):
10432005-444104 Vendor# 173 (N/A if new vendor) Vendor is a BOCC consultant? Yes Li No Contract
Type: (Check one)New El Renewal Z Amendment El Effective Date Q7191/15 Approved by Board Yes0
Nop Agenda Date:
This agreement is approved as to technical form and content:
DocuSigned by:
Department Director's Signature tlita
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B7Ege2D1BF454 FA ,,,,: 11/30
J tv _ /2015
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Information Technologies,
(Applicable only to hardwarelsgfiware 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:
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Risk Management
This agreement is approved for sufficiency of insurance standards,specifications, and requirements:
,.—DocuSigned by:
Office of the Risk Management Officer aGS6t CIA/IA-Ali-6
7FDCFg176800498 Date: 12/1/2015
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
DocuSigned by:
Office of the Chief Financial Officer,., rq"-N 4,1-41.14.•0-
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7D4E5181ACC1409 Date: 12/14/2015
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office OA ce of the County Attorney -, , 1
inkt,__
4035C B8304CA4AG Date:,12/14/2015
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion ce.i: DAJoyd@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date: _