HomeMy WebLinkAboutR 2016-114 Aging - NC Department of Insurance, Division of SHIIP for Senior Health Insurance info ORANGE COUNTY—DEPARTMENT USE ONLY /� ^ I `�—
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Department t
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: $4,201 Purpose: Senior Health Insurance Information Program Budget Code(s):
10432005-444104 Vendor# 173 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract
Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 07/01/2015 Approved by Board Yes❑
Nor-1 Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature 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 sufficiency of insurance standards, specifications,and requirements:
Office of the Risk Management Officer_ / (,Tr �Date: Ilk
Financial Services
This instrument has been pre-audited in the er re ' ed by he ocal Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date:
Legal Services
r
This agreement is approved as to lega fb nd su i cy:
Office of the County Attorney Date: Z�
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydg-oran ecountync.gov
The following signature block is for hard copies on t requ d for Docusign contracts:
Office of the Clerk to the Board Date: kyllf-