HomeMy WebLinkAboutR 2017-259-E Health - Cynthia Gamble, DDS for dental services DocuSign Envelope ID:572F6418-39E1-4F6F-B960-93B2BCCA7F05
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 7/1/2017 Approved by Board Yes No Agenda Date:
This agreement is approved as to to at 'rm e 'd co,tent:
LXottu1 �,l 6/29/2017
Department Director's Signature 5145A2CD945c40F... 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 sufficienc
rn gffs"5i $_ 'staandards,specifications, and requirements:
UtSi. bleu/ 7/3/2017
Office of the Risk Management Officer 7FDCF9176800498... Date:
Financial Services
This instrument has been pre-audited i alfORFIVNuired by the Local Government Budget and Fiscal Control Act:
(71.4.,p ` mini.'`". 7/3/2017
Office of the Chief Financial Officer zD4F5181ACC1409 Date:
Legal Services
This agreement is approved as t e// °agcyo tle abed suffciency:
"` A., f 6S0 7/3/2017
Office of the County Attorney 079A4D525C0F4FB... Date:
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:
Rev. 6/16 8