HomeMy WebLinkAboutR 2019-347 Health - Melynee Falk audiology services DocuSign Envelope ID:35E8DCE7-1CAA-4177-A55F-37F14DE3307B
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Melynee Falk Party/Vendor Contact Person: Melynee Falk Contact Phone: 336-402-1025
Party/Vendor Address: 1406 Valleymede Rd. City Greensboro State: NC Zip: 27410 Department: Health
Amount: $77,597 Purpose: Regional audiology consulting services Budget Code(s): 10414020-630000-71423
Vendor#64366 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)
New❑ Renewal® Amendment ❑ Effective Date 6-1-19 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement:
DocuSigned by:
is S�.wo- 6/11/2019
Department Director's Signatur 3C16F2D09E3445F. Date:
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that
was addressed: Forgot the agreement was on the State addendum fiscal year(June-May).Required contract for
State addendum.Reimbursed by State for services.
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficient Wcusigned_by:
. rds,specifications,and requirements:
USA, CbV1n.t,{�6 6/18/2019
Office of the Risk Management Office 7F❑CF917e800498. Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
CC 6/19/2019
Office of the Chief Financial Officer 704E5181ACC1409. Date:
-
Legal Services
This agreement is approved as t DocuSigned by:
QlrtAAk N-AKif, l v$Cb 6/19/2019
Office of the County Attorney 079MD525COF4FB. 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 12/18
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