HomeMy WebLinkAboutR 2017-366 Health - UNC School of Dentistry for resident dental services '7
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: UNC School of Dentistry Party/Vendor Contact Person: Shama Hill Contact Phone: 919-
537-3574 Party/Vendor Address: CB#7450 City Chapel Hill State:NC Zip:27599 Department:Health Amount:
$63,424 Purpose: Resident dental services Budget Code(s): 10410120-630000 Vendor # 36302 (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 technical form and content: �r
Department Director's Signature Date: D
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 sufficiency/offiinsurance standards,specifications,and requirements:
Office of the Risk Management Officer(E - Date:_1.f/ 7�
Financial Serv'
This instrument has been pre-audited in the e r q fedthe Local Government Budget and Fiscal Control
Act: 7
Office of the Chief Financial Officer Date: g
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney v�CLU. ���"� Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecogpty!!c.gov
The following signature block is for hard copies only and is n required for Docusign contracts:
Office of the Clerk to the Board Date: ���1 7
Rev. 6/16