HomeMy WebLinkAboutR 2016-121 Aging - UNC at Chapel Hill for physical therapy assessments ORANGE COUNTY-DEPARTMENT USE ONLY
epartment
Party/Vendor Name: University of North Carolina at Chapel Hill Party/Vendor Contact Person: Valerie Tan
Contact Phone: 919-843-4828 Party/Vendor Address:Allied Health Sciences,CB 7120 City Chapel Hill State:
NC Zip: 27599-7120 Department: Aging Amount: $10,000 Purpose: physical therapy assessments Budget
Code(s); 430320-630000 Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑
Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 05/01/2014 Approved by Board
Yes[]No❑ Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature Date: A170
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency of insurance standards,specifications,and requirements:
Office of the Risk Management Officer 4 Date:
Financial Services
This instrument has been pre-audited in the m er re uired by he Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date:"ty 6
Legal Services
This agreement is approved as to legal fo d sul ency:
S
Office of the County Attorney Date: 2$ t
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydnorangecountync•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: