HomeMy WebLinkAboutR 2018-668 Health - Planned Parenthood professional services agreementRevised 10/17
ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Planned Parenthood South Atlantic Party/Vendor Contact Person: Nancy Long Contact
Phone: 919-833-7526 x 6131 Party/Vendor Address: 100 S. Boylan Ave. City Raleigh State: NC Zip: 27603
Department: Health Amount: $5,040 Purpose: Perform vasectomies for referred Orange County patients Budget
Code(s): 10414020-630000-71400 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes
No Contract Type: (Check one) New Renewal Amendment Effective Date 10/5/18 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 Risk Management_____________________________________________ 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:
Office of the Clerk to the Board __________________________________________Date:_________
DocuSign Envelope ID: 32C22978-D1B8-4515-AD1A-21853E88FAA8