HomeMy WebLinkAboutR 2018-364 Health - Piedmont Health Services medical servicesRevised 7/18
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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: $35,482 Purpose: REGISTERED DIETITIAN SERVICES Budget
Code(s): 10414005-443110-71411 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: 1F50F7AE-561F-49AE-AF6E-02EC3D46985C
8/6/2018
8/6/2018
8/8/2018
8/8/2018