HomeMy WebLinkAboutR 2017-670-E Health - NCPHA Quitline programRevised July 2015
ORANGE COUNTY—DEPARTMENT USE ONLY
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Department
Party/Vendor Name: North Carolina Public Health Association Party/Vendor Contact Person: Lynette Tolson Contact
Phone: 919-828-6201 Party/Vendor Address: P222 N. Person Street, Suite 208 City Raleigh State: NC Zip: 27601
Department: Health Amount: $8,000 Purpose: Smoking cessation coaching Amendment to contract #2017-515-E Budget
Code(s): 10412020-680070-71459 Vendor # 36241 (N/A if new vendor) Vendor is a BOCC consultant? Yes No
Contract Type: (Check one) New Renewal Amendment Effective Date 11-1-17 Approved by Board Yes No
Agenda Date: 10-17-17
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 Donna Lloyd upon completion @ Dolloyd@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: 8D708CB5-7878-411F-96C8-760923F5F3C2