HomeMy WebLinkAboutR 2019-399 Health - Diane Shugars DDS dental services DocuSign Envelope ID:97238CE2-BA88-43FC-BB15-3276F9D37D17
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Diane Shugars, DDS Party/Vendor Contact Person: Diane Shugars, DDS Contact Phone: 919-
697-9251 Party/Vendor Address: 4321 Fearrington Post City Pittsboro State: NC Zip: 27312 Department: Health
Amount: $24,000 Purpose: Dental Services Budget Code(s): 10410120-630000 Vendor# 56709 (N/A if new vendor)
Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑
Effective Date 7/1/2019 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:
DaeuSigned by:
ljia' S�.w� 71212 019
Department Director's Signature113C16F2D09E3445F_ 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 oocuSigned by: rds, specifications,and requirements:
aUsa �,DVIn.�,{�6 7/2/2019
Office of the Risk Management Office 7FDCF9176900498. Date:
Financial Services
This instrument has been pre-audited it Docusigned by: the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer 704E51S1ACC1409. Date:7/2/2019
Legal Services
This agreement is approved as t Docusigned by: {�
gkAk Auvit, 7/2/2019
Office of the County Attorne 079MD525COF4Fa. 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:
Rev. 6/19 8