HomeMy WebLinkAboutR 2016-423-E Health - Jennifer Durham Crisp for dental services DocuSign Envelope ID:4250E623-7DB7-4E1C-AF70-8lC64E3C944F
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Jennifer Durham Crisp Party/Vendor Contact Person: Jennifer Durham Crisp Contact Phone: 919-
412-3568 Party/Vendor Address: 10017 River Bank Drive City Raleigh State: NC Zip: 27614 Department: Health
Amount: $9,800 Purpose: Dental Services Budget Code(s): 10410120-630000 Vendor # N/A (N/A if new vendor)
Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑
Effective Date 8/1/2016 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to to n&F`lb?W$Yid c ntent:
�� � 8/3/2016
Department Director's Signature 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 sufficiencNMf-iY PMltlb_egt'anndards,specifications, and requirements:
�!Ausol (hnutl6 8/3/2016
Office of the Risk Management Officer 7FDCF9176800498... Date:
Financial Services
DocuSi ned b
This instrument has been pre-audited i t e manner 6quired by the Local Government Budget and Fiscal Control Act:
� L 8/3/2016
Office of the Chief Financial Officer 7D4E5181ACC1409... Date:
Legal Services
This agreement is approved as t egWf fi4fd d sufficiency:
� 8/4/2016
Office of the County Attorney 4 Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollo dkoran eg countync. oovv
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