HomeMy WebLinkAboutR 2018-342 Health - UNC School of Dentistry dental servicesORANGE COUNTY - DEPARTMENT USE ONLY a 01�,- 3y�
Department
Party/Vendor Name: UNC School of Dentistry Party/Vendor Contact Person: - Shayna Hill Contact Phone: 919-
537 -3574 Party/Vendor Address: CB #7450 City Chapel Hill State: NC Zip: 27599 Department: Health Amount:
$66,595 Purpose: Resident dental services Budget Code(s): 10410120- 630000 Vendor #.36302 (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 tec ' 1 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
Risk Management
Date:
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 7nn/required by the Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer
Legal Services
Date: / 0
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney i �*4&A, 43 Y& Date: S110h%
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion @ Singersollgoran eg countync.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:
Rev. 6/18