HomeMy WebLinkAboutR 2018-546 Health - Chatham Co Public HD service agreementRevised 10/17 (Mgr apprv 5k 6/18)
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ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Chatham County Public Health Department Party/Vendor Contact Person: Tara Gregory
Contact Phone: 919-742-5641 x 8266 Party/Vendor Address: 1000 S. 10th Ave. City Siler City State: NC Zip: 27344
Department: Health Amount: $2,250 Purpose: Replication of CHG voucher program Budget Code(s): 10414020-
680007-71424 Vendor # 51966 (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, specificatio ns, 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: AEA61665-4A19-4F8B-8D63-8B3810AE559A
9/6/2018
9/7/2018
9/7/2018
9/7/2018