HomeMy WebLinkAboutR 2016-619-E Finance - Planned Parenthood South Atlantic - Outside Agency Performance Agreement DocuSign Envelope ID: CBOC1343-06EB-4BE7-9AF6-62EE77BD69FE
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Planned Parenthood South Atlantic Party/Vendor Contact Person: Jenny Contact Phone:
919-833-7526 x6140 Party/Vendor Address: 1765 Dobbins Drive City Chapel Hill State: NC Zip: 27514
Department: Finance & Administrative Services Amount: 20000 Purpose: Outside Agencies Funding Budget
Code(s): 10495050-710013 Vendor# 800040 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑
Contract Type: (Check one)New® Renewal❑ Amendment ❑ Effective Date 7/1/16 Approved by Board Yes
®Nor-1 Agenda Date: 6/21/16
This agreement is approved as to technical forma Njtft-d by:
Department Director's Signature t� nnG�, 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 sufficiency of insuran t&UdW4s,bspecifications,and requirements:
aura. COV'lnd 6
Office of the Risk Management Officer 7F0Cf94jZ8004N Date:
Financial Services
This instrument has been pre-audited in the manner r qui T i�yLocal Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer rmn Date:
naFS�g�nrr�anq
Legal Services
This agreement is approved as to legal form and suf cleignea by:
Office of the County Attorney nar D 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:
(Planned Parenthood South Atlantic)
Orange County Outside Agency Performance Agreement
Rev. 8116