HomeMy WebLinkAboutR 2017-389 Health - UNC Health Care System to perform tubal ligations for uninsured women ORANGE COUNTY-DEPARTMENT USE ONLY
Denartment
Party/Vendor Name: UNC Health Care System Party/Vendor Contact Person: Kathryn Grant Contact Phone:984-
974-1274 Party/Vendor Address: 211 Friday Center Drive City Chapel Hill State:NC Zip:27217 Department: ui(
Health Amount: JjQ&00 Purpose: Perform tubal ligations for uninsured women Budget Code(s): 10414020-
630000 Vendor#21680 (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[] 1
Agenda Date:
This agreement is approved as to technical form and content:
Department Director's Signature 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 M`nag m n
This agreement is approved for sufficiency of insurance standards,,specifications,and requirements:
Office of the Risk Management Officer �/�—�- ,. / / Date: � 3/( 7
This instrument has been pre-audited in the anne equired the Local Government Budget and Fiscal Control
Act: ;
i
Office of the Chief Financial Officer Date: 'S 2 3
Legal Services
This agreement is approved as to legal form and sufficiency: y
Office of the County Attorney i 1z /�' -L, Date: �J a2$11
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 co n i n equired for Docusign contracts:
Office of the Clerk to the Board �-- Date: j
06VOSM160CX 61 9