HomeMy WebLinkAboutR 2017-327-E Health - Piedmont Health Services, Inc. - Amendment to Komen Grant Support Agreement DocuSign Envelope ID:BE949AA1-4694-4E6D-9DBA-90D729491FE0
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Piedmont Health Services, Inc .Party/Vendor Contact Person: Jen Cunningham Contact Phone: (919)
913-1097 Party/Vendor Address: PO Box 17179 City Chapel Hill State: NC Zip: 27516 Department: HEALTH Amount:
Purpose: Komen Grant Support Agreement Amendment to contract 2016-337-E Budget Code(s): 30414020-680019-71132
Vendor#27868 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ❑
Renewal❑ Amendment ® Effective Date 4/1/17 Approved by Board Yes No Agenda Date:
This agreement is approved as to to 9 PPff content:
bV0 7/11/2017
Department Director's Signature 5145A7C11945f14OF 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 q �s %'s'taandards,specifications, and requirements:
attSa. Corr .c,ltb 7/18/2017
Office of the Risk Management Officer 7FM-F91758O049R Date:
Financial Services
This instrument has been pre-audited i ePffalifirt Yiequired by the Local Government Budget and Fiscal Control Act:
el a9tiy ArbitilaosL 7/18/2017
Office of the Chief Financial Officer 7P4F51R1ACC1409 Date:
Legal Services
This agreement is approved as t e Rr 1�4f'a 1'd Buff ciency:
ff 'f' f' -Sfa 7/18/2017
Office of the County Attorney 079A4D52SCOF4FB... 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:
Revised July 2015