HomeMy WebLinkAboutR 2016-296 HR - UNC Dept. of Family Medicine - Agreement between OC - UNC-CH for Its Dept. of Family Medicine in the School of Medicine ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: UNC Department of Family Medicine Party/Vendor Contact Person: Kevin Tate
Contact Phone: 919-843-6882 Party/Vendor Address: CB #7595, 590 Manning Drive City Chapel Hill
State: NC Zip: 27514 Department: Department of Family Medicine ount: $25,000.00 Purpose:
Health Screening and Health Coaching Budget Code(s): 10295020/72002 endor#21243 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑No X Contract Type: (Check one)New X Renewal ❑
Amendment ❑ Effective Date 5/1/2016 Approved by Board Yes❑No X Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature��„�(A, �G�..t�/ Date:
,S/2,31.201 (o
Information Technologies
(Applicable only to hardware/sofdware 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 standar s,speeci�fic-a-tiions,and requirements:
Office of the Risk Management Officer Date:
Financial Services
This instrument has been pre-audited in the nne ire y the Local Government Budget and Fiscal
Control Act:
Office of the Chief Financial Officer Date: �b
Legal Services
This agreement is approved as tIle . a u ciency:
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 @ Dolloydkorangecountync.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• Z
—/W