HomeMy WebLinkAboutR 2019-394 Health - Brian Swift DDS dental services DocuSign Envelope ID: 17C156AE-5EFE-4837-87B8-36CA89E13B8C
ORANGE COUNTY-DEPARTMENT USE ONLY
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: $6,400 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 7-1-19 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:
S&Wof 6/27/2019
Department Director's Signature ac,sF2oosEsaa5F. 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 -docuSig/Pn�ed_ .by: rds,specifications,and requirements:
��Sa (.,oVln.��b 7/1/2019
Office of the Risk Management Officer 7FDCF917E800498. Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer .6 � Date: 7/2/2019
7n4E51S1ACC1409.
Legal Services
This agreement is approved as t DocuSigned by:
§WAk lka�Vit, I 7/2/2019
Office of the County Attorney Date:
079A4D525COF4Fg.
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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