HomeMy WebLinkAboutR 2016-122 Aging - UNC at Chapel Hill for physical therapy assessments ORANGE COUNTY-DEPARTMENT USE ONLY /'% / 10
Department
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: 7599-7120 Department: Aging Amount: $12,000 Purpose: physical therapy assessments Budget
Code(s • 9430320-630000 Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant? Yes[:1 No❑
Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective Date 05/01/2015 Approved by Board
Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature Date: /-,2o•16
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—z2&__ AO — Date: / l h
Financial Services
This instrument has been pre-audited in the m er r quired by t e Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date:
Legal Services
This agreement is approved as to legal fo d s cy:
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 @ Dolloyd a,oran ecountync.eov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date: