HomeMy WebLinkAboutR 2018-297 Health - Diane Shugers dental services agreementRev. 7/18 8
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Diane Shugars, DDS Party/Vendor Contact Person: Diane Shugars, DDS Contact Phone: 919-
697-9251 Party/Vendor Address: 4321 Fearrington Post City Pittsboro State: NC Zip: 27312 Department: Health
Amount: $24,000 Purpose: Dental Services Budget Code(s): 10410120-630000 Vendor # 56709 (N/A if new vendor)
Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment
Effective Date 7/1/2018 Approved by Board Yes No 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 Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by 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 __________________________________________Date: ________
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion @ Singersoll@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board __________________________________________Date:_________
DocuSign Envelope ID: A1726A79-7A79-4808-BB81-5CEFD862D855
7/17/2018
7/19/2018
7/19/2018
7/20/2018