HomeMy WebLinkAboutR 2018-420 Health - Randolph Faulk dental servicesRevised 10/17 (Mgr apprv 5k 6/18)
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ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Randolph Kelly Faulk, Jr. Party/Vendor Contact Person: Randolph Kelly Faulk, Jr. Contact
Phone: 919-770-5870 Party/Vendor Address: 1811 Holiday Road City Sandord State: NC Zip: 27330 Department:
Health Amount: $800 Purpose: Professional dental services Budget Code(s): 10410120-630000 Vendor # n/a (N/A if
new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal
Amendment Effective Date 7-17-18 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: B368014E-191B-48DC-B144-E5DF6E9FA4E2
8/16/2018
8/16/2018
8/16/2018
8/16/2018