HomeMy WebLinkAboutR 2017-075 Health - UNC Health Care System to perform tubal ligations for uninsured women ORANGE COUNTY-DEPARTMENT USE ONLY 2.0 I �y 0 n9
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Deartment I •
Party/Vendor Name: UNC Health Care System Party/Vendor Contact Person: Kathryn Grant Contact Phone:984-
974-1274 Party/Vendor Address: 211 Friday Center Drive City Chapel Hill State: NC Zip: 27217 Department:
Health Amount: $30,000 Purpose: Perform tubal ligations for uninsured women Budget Code(s): 10414020-J�
630000-71406 Vendor#21680 (N/A if new vendor) Vendor is a BOCC consultant? Y®s No® Contract Type:
(Check one)New ® Renewal ❑ Amendment ❑ Effective Date 7-1-16 Approved by Board Yes❑ No❑
Agenda Date:
This agreement is approved as to technical form and content:
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 sufficiency of insurance standards,specifications,and requirements:
Office of the Risk Management Officer �� _ A Date:_r7//yi'
Financial Services
This instrument has been pre-audited in the m r re d by LGovernment Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date: Z t/s 7
Legal Services
This agreement is approved as to legal o d Buff ie
Office of the County Attorney Date: 1'7
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyh upon completion @ DolloydP_oran ecountync.-og_v
The following signature block is for hard*)16d is not required for Docusign contracts:
Office of the Clerk to the Board Date:3
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