HomeMy WebLinkAboutR 2016-113 Aging - NC Department of Insurance, Division of SHIIP for Medicare improvements ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: NC Department of Insurance,Division of SHIIP Party/Vendor Contact Person: Van Braxton
Contact Phone:919-807-6900 Party/Vendor Address: 11 S Boylan Ave City Raleigh State: NC Zip: 27603
Department: Aging Amount: $1,933 Purpose: Medicare Improvements for Patients and Providers Act Budget
Code(s): 10432005-444128 Vendor# 173 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No®
Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 10/01/2015 Approved by
Board Yes❑Non Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature ".4 Date:
Information TechnoloLies
(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 sufficiency of insurance standards,specifications,and requirements:
Office of the Risk Management Officer- Date:
Financial Services
This instrument has been pre-audited in the 4rqu* d b y the Local Government Budget and Fiscal Control L Act:
Office of the Chief Financial Officer Date: I
Legal Services
This agreement is approved as to legal f d suffi e cy:
Office of the County Attorney Date: LL tj�,
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountvnc.gov
The following signature block is for hard copie �o d is t required for Docusign contracts:
Office of the Clerk to the Board Date: Z� /