HomeMy WebLinkAboutR 2017-267-E Health - M. Monica Meng-Haggerty, DDS for dental services DocuSign Envelope ID:31D3934C-CE6C-4B6A-A77D-A2C78EC2A7A3
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: M. Monica Meng-Haggerty, DDS Party/Vendor Contact Person: M. Monica Meng-Haggerty,
DDS Contact Phone: 919-816-6493 Party/Vendor Address: 215 Bluefield Rd. City Chapel Hill State: NC Zip: 27517
Department: Health Amount: $11,200 Purpose: Dental Services Budget Code(s): 10410120-630000 Vendor# 62571
(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 n 1lll�d ��d�content:
bV0 t�VUt 7/5/2017
Department Director's Signature F14FG2r non,,r4rnF... 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 Lida.i,r neitystandards, specifications,and requirements:
aMtSA. 6.61(W. 6 7/5/2017
Office of the Risk Management Office Date:
$FOCronsBOOa9a...
Financial Services
This instrument has been pre-audited i cPtidiffiWitquired by the Local Government Budget and Fiscal Control Act:
Aniiiio,ox. 7/5/2017
Office of the Chief Financial Officer znaFetatnco14o9 Date:
Legal Services
This agreement is approved as t e of f�4f`a3'd stiff ciency:
ff 'f' f' -Sfa 7/6/2017
Office of the County Attorney o�9aa�szec0F4Fa... 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