HomeMy WebLinkAboutR 2017-262-E Health - Diane Shugars, DDS for dental services DocuSign Envelope ID:440B28DD-5CC9-4584-A4BA-B6C20A397882
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Diane Shugars, DDS Party/Vendor Contact Person: Diane Shugars, DDS Contact Phone: 919-
697-9251 Party/Vendor Address: 136 Owen Towne Rd. City Chapel Hill State: NC Zip: 27516 Department: Health
Amount: $9,800 Purpose: Dental Services Budget Code(s): 10410120-630000 Vendor# 56709 (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 tec WI' da content:
V61(.0 6/29/2017
Department Director's Signature 9145A7c.no45f;4aF_ 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 n Qn s , tandards,specifications, and requirements:
U.�tSA. rbIrl&t 7/3/2017
Office of the Risk Management Officer 79ncF91768004.8... Date:
Financial Services
This instrument has been pre-audited i e°ffi'W itlial Tquired by the Local Government Budget and Fiscal Control Act:
(71 An a°9Z 7/3/2017
Office of the Chief Financial Officer zo4F5181Acc14o9 Date:
Legal Services
This agreement is approved as t cRiltlid d sufficiency:
liu lit,t, f' S(b 7/3/2017
Office of the County Attorney., 079n4eseF4Fe... 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