HomeMy WebLinkAboutR 2016-401-E Health - Diane Shugars to provide dental services DocuSign Envelope ID: DAAE2CBD-CD76-4858-84F5-E9B3F7DOOBBC
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: DIANE SHUGARS Party/Vendor Contact Person: DIANE SHUGARS Contact Phone: 919-967-
9251 Party/Vendor Address: 136 OWEN TOWNE RD City CHAPEL HILL State: NC Zip: 27516 Department:
HEALTH Amount: $9.800 Purpose: DENTAL SERVICES Budget Code(s): 10410120-630000 Vendor# 56709 (N/A
if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal
Amendment ❑ Effective Date 7/1/2016 Approved by Board Yes❑Nor-1 Agenda Date:
This agreement is approved as to to mca�° or"m acid content:
�` 6 "� 7/23/2016
Department Director's Signature C9ED9D0FCSB545E... Date:
Information Technolo0es
(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 /A4gt�' '"c'y�5t�a�ndards, specifications,and requirements:
QUSA, rbrv�,c 6 7/25/2016
Office of the Risk Management Officer 7FDCF9176800498... Date:
Financial Services
This instrument has been pre-audited i t e°manger 964uired by the Local Government Budget and Fiscal Control Act:
7/25/2016
Office of the Chief Financial Officer Lita
4E51a1ACC1409... Date:
Legal Services
This agreement is approved as t 7,q'FY8M'J`Id sufficiency:
4� 7/25/2016
Office of the County Attorney 35CE8304CA4A9_ Date:
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:
Rev. 6/16 9