HomeMy WebLinkAboutR 2018-475 Finance - Piedmont Health Services Inc outside agency agreementDocuSign Envelope ID: CCFF6125- AA47- 438A- 98CA- B42519499D42
ORANGE COUNTY - DEPARTMENT USE ONLY
Department
Party/Vendor Name: Piedmont Health Services Party/Vendor Contact Person: Brian Toomey Contact Phone: 919-
933 -8494 Party/Vendor Address: 127 Kingston Drive City Chapel Hill State: NC Zip: 27514 Department: Finance
& Administrative Services Amount: 16500 Purpose: FY 2018 -19 Outside Agency /Human Services Performance
Agreeement Budget Code(s): 10495050- 719021 Vendor # 27898 (N /A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date
7/1/2018 Approved by Board Yes[] No❑ Agenda Date: 6/19/2018
This agreement is approved as to technical for i)ocusigned by:
8/23/2018
Department Director's Signature Date:
704E5181ACC1409...
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
This agreement is approved for sufficiency of in, DocuSigned by:
Office of the Risk Management Officer 7F6CF917E800498...
Financial Services
This instrument has been pre- audited in them oocu5igned by:
Office of the Chief Financial Officer 704E5181ACC1409...
Legal Services
This agreement is approved as to legal formC�4035CB8'304CA4M...
ocuSigned by:
4k�1,,w�
Office of the County Attorney
Clerk to the Board
Date:
;cifications, and requirements:
8/24/2018
Date:
al Government Budget and Fiscal Control Act:
Date: 8/23/2018
Date:
8/24/2018
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion @ sin erg sollgoran eg countync. og_v
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
(Piedmont Health Services)
Orange County Outside Agency Performance Agreement Page 6 of 9
Rev. 7118