HomeMy WebLinkAboutR 2019-086 Health - Brian Swift Service Agreement amendment DocuSign Envelope ID:AF952183-DCC6-47F3-9841-1B9C7887DC3D
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Brian Swift Party/Vendor Contact Person: Brian Swift Contact Phone: 919-824-0942 Party/Vendor
Address: 4010 Sweeten Creek Road City Chapel Hill State:NC Zip: 27514 Department: Health Amount: $2,400 Purpose:
Professional dental services Budget Code(s): 10410120-630000 Vendor#65279 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ❑ Amendment ® Effective Date 2-18-19
Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this
project has not been initiated prior t 11 :the agreement:
avUA" S&Wavl 2/14/2019
Department Director's Signature Date:
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have
already begun or been completed please briefly describe the nature of the emergency condition that was addressed:
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 sufficienc nataawstandards, specifications,and requirements:
QUS& CbV'�t,t b 2/15/2019
Office of the Risk Management Officer �FB6F9�76800498... Date:
Financial Services
This instrument has been pre-audited i ja&W quired by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer +�.� Date: 2/18/2019
tC•p ro,'-A8C1109...
Legal Services
This agreement is approved as t rid sufficiency:
al�tl�l�, Auk, T�S(A 2/18/2019
Office of the County Attorne 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:
Revised Dec 2018