HomeMy WebLinkAboutR 2016-553-E Health - Cynthia Gamble, DDS for dental services DocuSign Envelope ID:52078629-O005-490E-B927-912B1A72FEB1
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: CYNTHIA GAMBLE,DDS Party/Vendor Contact Person: CYNTHIA GAMBLE Contact Phone:
919-380-1042 Party/Vendor Address: 114 OAKMIST DR. City CARY State: NC Zip: 27513 Department: HEALTH
Amount: $5,600 Purpose: DENTAL SERVICES Budget Code(s): 10410120-630000 Vendor # 59544 (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 tec n Mc"flgdA�,d'ryc ntent:
Iv` 9/26/2016
Department Director's Signature Date:F it
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 sufficienc l'l_�'s'tllandards,specifications, and requirements:
aLtSA. bvvutl6 9/26/2016
Office of the Risk Management Officer 7FDCF9176800498... Date:
Financial Services
This instrument has been pre-audited i e fVAMV Ytquired by the Local Government Budget and Fiscal Control Act:
�� 10/3/2016
Office of the Chief Financial Officer Date:
Legal Services
This agreement is approved as t egRPT1W 7h i sufficiency:
��
Office of the County Attorney -� Date: 10/4/2016
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 g