HomeMy WebLinkAboutR 2018-358 Health - Piedmont Health Services WIC agreementPHS/OCHD Memo of Agreement
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ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Piedmont Health Services Party/Vendor Contact Person: Ashley Brewer Contact Phone:
336-382-0242 Party/Vendor Address: 127 Kingston Drive City Chapel Hill State: NC Zip: 27514 Department:
Health Amount: $10,000 Purpose: Reimbursement for WIC Hemoglobin Testing Budget Code(s): 10414001-
476020-71403 Vendor # 27898 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract
Type: (Check one) New Renewal Amendment Effective Date 7/1/18 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: 479CCDE6-7805-4D93-82FB-D6ED0CEE182C
8/6/2018
8/6/2018
8/7/2018
8/7/2018