HomeMy WebLinkAboutR 2019-303 Emergency Svc - NCHIEA participation agreement DocuSign Envelope ID:47B4445A-C7CA-4D2E-9075-2AFD82F82DEC
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: NC Health Information Exchange Authority Party/Vendor Contact Person: Legal Team
Contact Phone: 919-754-6928 Party/Vendor Address: Mail Service Center 4101 City Raleigh State: NC Zip:
27699-4101 Department: Orange County Emergency Services - EMS Amount: $0.00 Purpose: State mandated
electronic health information exchange network agreement Budget Code(s): NA Vendor # NA (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑
Amendment ❑ Effective Date June 1,2019 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 to execution of the agreement:
UoeuSigned by:
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Department Director's Signature Date: 5/29/2019
.
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 any' oacu5igned by:
Office of the Chief Information Officer ik 4&ny Date: 5/29/2019
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, -- oeuSigned dy:
Office of the County Attorney �'°' - Date: 5/29/2019
O
E4035C@8304CA4A9
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 12/18