HomeMy WebLinkAboutR 2015-634-E Health - NC Public Health Foundation for Quit Line Amendment DocuSign Envelope ID:4C485144-3EA1-4A86-8777-0808354A83DE
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
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 # 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 'c9ME tid ontent:
6,6&AAA, 15n '0 ' 12/18/2015
Department Director's Signature ceEDSOOFCSes4sE... 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 I worstandards,specifications,and requirements:
QUSA, Cord..*& 12/19/2015
Office of the Risk Management Officer 7E1JGFg17680A498 Date:
Financial Services
This instrument has been pre-audited i by the Local Government Budget and Fiscal Control Act:
,„../.. z 12/20/2015
Office of the Chief Financial Officer Date:
7.mbuttuPequired
51�1�t,14b9...
Legal Services
This agreement is approved as toekgsloimmend sufficiency:
Office of the County Attorney 4 �` Date: 12/21/2015
y 4033CB6004CA4A9...
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@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:
Revised July 2015