HomeMy WebLinkAboutR 2016-402-E Health - M. Monica Meng-Haggerty, DDS to provide dental services DocuSign Envelope ID: BDC7A23B-OD7B-4786-8452-D97DA48C507E
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: M. MONICA MENG-HAGGERTY, DDS Party/Vendor Contact Person: M. MONICA MENG-
HAGGERTY Contact Phone: 919-816-6493 Party/Vendor Address: 215 BLUEFIELD RD. City CHAPEL HILL State:
NC Zip: 27517 Department: HEALTH Amount: $11.200 Purpose: DENTAL SERVICES Budget Code(s): 10410120-
630000 Vendor# 62571 (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❑ No❑ Agenda
Date:
This agreement is approved as to to In fbFWP Kd content:
"— L--/y 7/23/2016
Department Director's Signature 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 sufficiencyuf�!FDCF9176800498 11saigt�dN)Standards, specifications,and requirements:
SA, (hVV,c,�16 7/25/2016
Office of the Risk Management Officer ... Date:
Financial Services
This instrument has been pre-audited i tmqTtyRfjrpjequircd by the Local Government Budget and Fiscal Control Act:
7/25/2016
Office of the Chief Financial Officer nnGS1�1P�G141 Date:
Legal Services
This agreement is approved as to�4035CE8304CA4A9 aP�ori anti sufficiency:
7/25/2016
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 @ 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