HomeMy WebLinkAboutR 2016-706 Health - UNC School of Dentistry for resident dental services ORANGE COUNTY-DEPARTMENT USE ONLY
Department
�arty/Vendor Name: UNC School of Dentistry Party/Vendor Contact Person: Shayna Hill Contact Phone: 919-
37-3574 Party/Vendor Address:CB#7450 City Chapel Hill S te:NC Zip:27599 Department: Health Amount:
5
Crvendor)60 403 Purpose: Resident dental services Budget Code(s 0410120-630000 Vendor # 36302 (N/A if new
Vendor is a BOCC consultant? Yes ❑ No® ontract Type: (Check one) New ❑ Renewal
Amendment ❑ Effective Date 7/1/16 Approved by Board es❑No❑ Agenda Date:
This agreement is approved as to technical Prm and content:
Department Director's Signature 2 Date: /,,?,;�7—/,
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 sufficiency of insurance standards,specifications,and requirements:
Office of the Risk Management Officer L�L_ j &_Vzz_ Date: l � / (p
Financial Services
This instrument has been pre-audited in them r requi by t Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date: 7- /
Le�a1 Services
This agreement is approved as to legal form ufficiency:
Office of the County Attorney Date: 1 L+
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloy pon completion @ Dolloydgorangecountync.gov
The following signature block is for hard y n is not required for Docusign contracts:
Office of the Clerk to the Board Date: 1 111//7
Rev. 6/16