HomeMy WebLinkAboutR 2016-337-E Health - Piedmont Health Services, Inc. for Komen Grant Data Support Services DocuSign Envelope ID:61B96AFO-9902-4072-B6BO-7716FB6AEOD3
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Piedmont Health Services,Inc. Party/Vendor Contact Person: Jen Cunningham Contact Phone:
(919) 913-1097 Party/Vendor Address: PO Box 17179 City Chapel Hill State: NC Zip: 27516 Department: Health
Amount: $2,304 Purpose: Komen Grant Data Support Services Budget Code(s): 30414020-680019-71132 Vendor#
27868 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑
Renewal® Amendment ❑ Effective Date 411115 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to to mEa4�%d content:
� '°�� 7/6/2016
Department Director's Signature r".. nnGCFasnsG Date:
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 sufficien MVP tft,:standards,specifications,and requirements:
a�Sa rbvvutl6 7/6/2016
Office of the Risk Management Office 7FD,F9176800498... Date.
Financial Services
This instrument has been pre-audited i t e"IfflO W�6:quired by the Local Government Budget and Fiscal Control Act:
Date: 7/6/2016
Office of the Chief Financial Officer Lj-t-A
4E5181ACC1409...
Legal Services
This agreement is approved as to e sufficiency:
Office of the County Attorney Date: 7/6/2016
Clerk to the Board
Received for record retention
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydgoran eg countync.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