HomeMy WebLinkAboutR 2017-624 Health - UNC Department of Family Medicine - Community Health Grant Subcontract ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: UNC Department of Family Medicine Party/Vendor Contact Person: Sherry Hay Contact
Phone: 984-974-4892 Party/Vendor Address: 590 Manning Drive City Chapel Hill State: NC Zip: 27599 M,
Department: Health Amount: $8,148 Purpose: Community Health Grant Subcontract Budget Code(s): 10414020- �v
630000-71424 Vendor#21243 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No® Contract Type:
(Check one) New ® Renewal ❑ Amendment ❑ Effective Date 9/1/17 Approved by Board Yes❑ NOD
Agenda Date: t�
This agreement is approved as to technical form and content:
i I
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 Management
This agreement is approved for sufficiency of insurance standards,specifications,and requirements:
Office of the Risk Management Officer azzn= Date:_Vag// 7
in ci 1 4vides
This instrument has been pre-audited in the in er uir e Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date:_4064
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney �{ 6 r � /C.'i4_1Y Date: 1 J1,10 I1-1
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upo�i'c�omplgt' n @ Dolloydkorangecountync.gov
The following signature block is for hard copies only abd is not're'Lii0d,for Docusign contracts: f
Office of the Clerk to the Board Date: I
Revised 6/17 4