HomeMy WebLinkAboutR 2016-123 Aging - UNC at Chapel Hill for occupational therapy assessments ORANGE COUNTY—DEPARTMENT USE ONLY c�)V (,p I or3
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: $14,000 Purpose: occupational therapy assessments Budget
Code(s)• 0432020-630000 Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑
Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 12/01/2014 Approved by
Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature Date: /-.to•/{o
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 �� � ,.f� Date:
Financial Services
This instrument has been pre-audited in the er aired Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date:Ayll L
Legal Services
This agreement is approved as to leg o an s ciency:
Office of the County Attorney Date: 1 ��
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloydAorangecoojync.gov
The following signature block is for hard copies only and is not required for Docusign contracts: