HomeMy WebLinkAboutR 2019-025 Health - UNC Dept of Family Medicine community health grant subcontract ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name : UNC Department of Family Medicine Party/Vendor Contact Person : Sherri Hay Contact
Phone : 984-9744892 Party/Vendor Address : 590 Manning Drive City Chapel Hill State : NC Zip : 2759
Department: Health Amount : $9, 365 Purpose : Community Health Grant Subcontract Budget Code(s) : 10414020-
630000=71424 Vendor # 21243 (NIA 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 .
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This agreement is approved as to technical form and copYt nt :
01
Department Director 's Signature asI I otiti A i A 0jate :
Information Technologies
(Applicable only to hard►vare/sojhvare 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 -� l Date : �
Finanki ! l iervices
This instrument has been pre- audited in the m n er re i by the Local Government Budget nd Fi al Control Act:
Office of the Chief Financial Officer Date: Z3
1170
Leaal Services
This agreement is approved as to legal form and sufficiency :
Office of the County Attorney i L L 1:C _Date : I 4 41 l
Clerk to the Board
Received for record retention :
All Docusign contracts must be copied to Sherri Ingersoll upon completion @ Singersol orangecounlync . pgov
The following signature block is for hard copies only and is not required for Docusign contracts :
Office of the Clerk to the Board Date :
Revised 7/ 18 4