HomeMy WebLinkAboutR 2017-388 Health - UNC Health Care System for BCCCP mammogram screenings ORANGE COUNTY—DEPARTMENT USE ONLY r q
Department
Party/Vendor Name: UNC Health Care System Party/Vendor Contact Person: Kathryn Grant Contact Phone: 984-
974-1274 Party/Vendor Address: 211 Fridgy Center Drive City Chapel Hill State: NC Zip: 27517.-Department-
Health Amount: $4,000 Purpose: BCCCP Mamogram Screenings Budget Code(s): 1041 -631010 Vendor #
30892 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract ype: (Check one) New "/�//7
Renewal® Amendment ❑ Effective Date 7/1/17 Approved by Board Yes❑No❑ Agenda Date: 1 O fN0_2_O
This agreement is approved as to technical form and content: &31 of Q
Department Director's Signature Date:1�� y� r7011 r
pe. /Ki►r/,
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 the Risk Management Officer Lam`- 10 Date: �'/Z /7
Financial Services
This instrument has been pre-audited in the er E e y the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 2 3
7
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney i y j 1 az �d C' Date: �
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Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkoran ee cozen nc.gov
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The following signature block is for hard copiea�nI an�s ngtt re. uired for Docusign contracts:,. )
Office of the Clerk to the Board G Date:
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Revised 6/17 4