HomeMy WebLinkAboutR 2016-479-E DSS - UNC Hospital - to provide one full time IMC worker and one part-time IMC supervisor DocuSign Envelope ID:6B6EBA29-C8D4-4113-B4DC-CEAE3FB1 14B7
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: UNCH Party/Vendor Contact Person: JI Campbell Contact Phone: (919) 966-7029
Party/Vendor Address: 101 Mannino Dr City, Chapel Hill State: NC Zip: 27514 Department: DSS Amount:
S42 587 Purpose: Provide one full time IMC worker and Budget Code(s):
10403005-442311 Vendor
(N/A if new vendor) Vendor is a BOCC consultant? Yes F-I No[] Contract
Type: (Check one) New ❑ Renewal M Amendment 0 Effective Date 07/0.,11'16 Approved by Board YesE
No❑ Agenda Date:
This agreement is approved as to technical form an 'igned by:
Department Director's Signature _ N" 666vu Date: 8/22/2016
tED'XE1_E_1_9_6_K8:TS_45
Information Technologies
(Applicable only to harchvarels((hvare purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Director of Information Technology--.—,--,. Date:
Risk Management
This agreement is approved for sufficiency of insur P,;o�st&, specifications,and requirements:
Office of Risk Management 7/7/2016
EME9_17BBDjM_qa__ Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: ed by:
Office of the Chief Financial Officer 8/22/2016
_f Date:
Le aal Services
This agreement is approved as to legal form and SL
Office of the County Attorney Date: 8/23/2016
Clerk to the Board
Received for record retention:
Office of the Clerk to the Board —Date:—,