HomeMy WebLinkAboutR 2017-623 Health - UNC Department of Family Medicine - Medical Director Services ORANGE COUNTY—DEPARTMENT USE ONLY ,-� ,�I /_✓�
Department
Party/Vendor Name: UNC Department of Family Medicine Party/Vendor Contact Person: Pam Hoover Contact
Phone: 919-966-3907 Party/Vendor Address: 590 Manning Drive City Chapel Hill State: NC Zip: 27599
Department: Health Amount: $157,000 Purpose: Medical Director Services Budget Code(s): 10414020-630000-
71400/71403/71406/71409/71414/71416 Vendor#21243 (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: `
1�
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 Management
This agreement is approved for sufficiency of insurance standards,specifications,and requirements:
Office of the Risk Management Officer al. lJ Date:��z
Financial Services
This instrument has been pre-audited in the in er ed b the Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer Date:
i-/J7
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney Irt r Date: I (/a2 0 V1
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 copies only and is pot requir d for Docusign contracts: '
Office of the Clerk to the Board Date: /7
13
Rev 6/17