HomeMy WebLinkAboutR 2017-371 Aging - Jennifer Womack, MS OTR/L, (UNC) for occupational therapy assessments ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY
Department
Party/Vendor Name: University of North Carolina at Chapel Hill Party/Vendor Contact Person: Kevin Castle
Contact Phone: Party/Vendor Address: 3114 Bondurant Hall, CB#7120 City Chapel Hill State: NC Zip:
27599 Department:Agin Amount: $15,000 Purpose: Occupational Therapy assessments Budget Code(s)>�
10432020-630000 & 10430020-630120 Vendor# 10419 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 12/01/16 (7
Approved by Board Yes[]No[] Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature 4, 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 sufficiency of insurance standards,specifications,and requirements:
Office of Risk Management /),
? _ — Date:�7
Financial Servicios
This instrument has been pre-audited in the ner red y the Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date:
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney (A", Date: $ 11
Clerk to the Board
Received for record retention:
Office of the Clerk to the Board Date:
Revised 2/17