HomeMy WebLinkAboutR 2017-702-E Health - CHCCS Carrboro elementary business associate agreementRevised 10/17
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ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Chapel Hill Carrboro County Schools Party/Vendor Contact Person: Dr. Rydelll Harrison
Contact Phone: 919-967-8211 Party/Vendor Address: 750 S. Merritt Mill Road City Chapel Hill State: NC Zip:
27516 Department: Health Amount: $2,200 Purpose: After school acceleration program. Budget Code(s):
10412020-630000-71453 Vendor # 22226 (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:
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: 10A8F60A-9470-4C26-880E-45549E28A702
Revised 10/17
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DocuSign Envelope ID: 10A8F60A-9470-4C26-880E-45549E28A702