HomeMy WebLinkAboutR 2016-325-E Health - The North Carolina Public Health Foundation for smoking cessation counseling DocuSign Envelope ID:91F43AFA-8CB4-4861-887A-F304C7A6614B
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: The North Carolina Public Health Foundation Party/Vendor Contact Person: Chuck Bridger
Contact Phone: 980-522-1621 Party/Vendor Address: PO Box 18763 City Raleigh State: NC Zip: 27619
Department: Health Amount: $5,000 Purpose: Smoking Cessation Counseling Budget Code(s): 10412020-680070-
71454 Vendor# 56861 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check
one) New ❑ Renewal ® Amendment ❑ Effective Date 7-1-16 Approved by Board Yes❑ No❑ Agenda
Date:
This agreement is approved as to to n %PMWhd content:
f,,._ E-6- 6/23/2016
Department Director's Signature C9EO9Q0FC6B545E_ Date:
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 sufficiency-of/ma&mmaeystandards, specifications,and requirements:
QUSA. r,Orv�,c,�16 6/24/2016
Office of the Risk Management Officer �sF hntt Date:
Financial Services
This instrument has been pre-audited in e q�u ed by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Li4E5181ACC1409... Date: 6/27/2016
Legal Services
This agreement is approved as t eg°a4`l'b"'ffifd sufficiency:
Office of the County Attorney a�,��,RR��a�,oaoa Date: 6/27/2016
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.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:
Revised 6/16 4