HomeMy WebLinkAboutR 2016-352-E Health - Family Centered Healthcare, PA - primary care for uninsured males of Orange County DocuSign Envelope ID:977F9724-OD69-4F35-BE42-796A38945969
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Family Centered Healthcare, PA Party/Vendor Contact Person: Amanda Dorthv 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): 10414020-630000-71422 Vendor # 63536 (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❑Nor-1 Agenda Date:
This agreement is approved as to to ea1u£ta"lind content:
Department Director's Signature �1_ Date: 7/6/2016
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 sufficient I' qtr ''l"" �'�tandards, specifications,and requirements:
QUSA rbrwc 116 7/6/2016
Office of the Risk Management Officer ,F �Fg„549� Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer rl� �an=arm. Date: 7/13/2016
ea€sa. ..
Legal Services
This agreement is approved as tq4egaicComcmd sufficiency:
Office of the County Attorney
��q 1-.1 Date: 7/13/2016
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:
Revised 6/16
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