HomeMy WebLinkAboutR 2016-115 Aging - UNC Hospitals for Wellness Program Director support ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: LTNC Hospitals Party/Vendor Contact Person: Susan Blalock Contact Phone: (984)974-1155
Party/Vendor Address: 211 Friday Center Dr., Suite G021 City Chapel Hill State: NC Zip: 27514 Department:
Aging Amount: $25,000 Purpose: Wellness Program Director Support Budget Code(s): 29430305-499999
Vendor#30892 (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❑No❑ 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 �a �vI-./ P5=— Date:
Financial Services
This instrument has been pre-audited in the er required b the Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date: ,
Legal Services
This agreement is approved as to legal nd suf c' y:
Office of the County Attorney Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg c�tync.gov
The following signature block is for hMo ' a is not required for Docusign contracts:
Office of the Clerk to the Board Date: 5