HomeMy WebLinkAboutR 2016-147-E Health - Family Centered Healthcare, PA to provide primary care for uninsured males in OC DocuSign Envelope ID:273B24CC-D965-44D0-A589-37C63CDFC6B6
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Family Centered Healthcare, PA Party/Vendor Contact Person: Amanda Dorthy Contact
Phone: 919-245-3247 Party/Vendor Address: 400 Millstone Drive, Suite 100 City Hillsborough State: NC Zip:
27278 Department: Health Amount: $30.000 Purpose: Provide Primary Care for uninsured males of Orange
Count Budget Code(s): 10414020-630000-71414 Vendor # 63536 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date
2/1/16 Approved by Board Yes❑Nor-1 Agenda Date:
This agreement is approved as to to /eatufl"and content:
Department Director's Signature bv4r Date: 1/28/2016
69EB99BFC-.F;B5 4 5E...
Information Technolosies
(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 sufficienc Iastandards, specifications,and requirements:
gusa. (hVV ,�16 1/28/2016
Office of the Risk Management Office Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: EDocuSigned by:
Office of the Chief Financial Officer Date: 2/9/2016
Legal Services
This agreement is approved as t eg9FT&4f Hd sufficiency:
Office of the County Attorney , Date:
2/16/2016
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Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.nic.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: