HomeMy WebLinkAboutR 2017-255-E Health - Kevin Kirk to provide group instruction for Diabetes Self-Management Education (DSME) Program DocuSign Envelope ID:A88B52D1-F83A-4024-B98D-A2DDO9F7BED6
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Kevin Kirk Party/Vendor Contact Person: Kevin Kirk Contact Phone: 919-419-0171
Party/Vendor Address: 5311 Beaumont Drive City Durham State: NC Zip: 27707 Department: Health Amount: $600
Purpose: Group instruciton for DSME program. Budget Code(s): 10414020-630000-71405 Vendor# 34783 (N/A if
new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ❑ Renewal
Amendment ❑ Effective Date 7-1-17 Approved by Board Yes No Agenda Date:
This agreement is approved as to to c°RI 1`iid content:
UM, tlAb 6/29/2017
Department Director's Signature F,4saa�e�a5s4aF 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 sufficient q soli :standards,specifications,and requirements:
l(UStt C,ortA ft b 6/29/2017
Office of the Risk Management Office 7F Date:
Financial Services
This instrument has been pre-audited irrtheffihhillePITquired by the Local Government Budget and Fiscal Control Act:
(71p `.6°0. 6°"` 6/29/2017
Office of the Chief Financial Officer , ,__ ,., Date:
Legal Services
This agreement is approved as t c d suf iency:
Office of the County Attorne Date: 7/2/2017
�.1 y 079A4D525C0F4FB
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd @orangecountync.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:
Revised 2/17 5