HomeMy WebLinkAboutR 2019-402 Health - Robert Dupuis pharmacy services DocuSign Envelope ID:CC89B49F-E2D0-47EA-B03D-9AE14E7378C8
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: ROBERT DUPUIS Party/Vendor Contact Person: ROBERT DUPUIS Contact Phone: 919-966-
4131 Party/Vendor Address: 205 KENILWORTH PLACE City CHAPEL HILL State: NC Zip: 27516 Department:
HEALTH Amount: $12,645 Purpose: PHARMACY SERVICES Budget Code(s): 10414020-630000/pro rg ams
Vendor#47361 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)
New❑ Renewal ® Amendment ❑ Effective Date 7/1/2019 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on
this project has not been initiated prior to execution of the agreement:
DocuSigned by:
S�_Wof 7/3/2019
Department Director's Signature aC1sF2oosEsaa5F. Date:
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that was
addressed:
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficienc, -i]ocusigned by: ds,specifications,and requirements:
Q�t$a �"'Wt't'�6 7/3/2019
Office of the Risk Management Officer_ 7FDCF9170800498. Date:
Financial Services
This instrument has been pre-audited ii Docusigned by: the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 7/3/2019
714E5181 AM 400
Legal Services
This agreement is approved as t D"uSigned by:
§WAk f-A.Y1t, l v$Cb 7/3/2019
Office of the County Attorney Date:
079A4n525C0F4Fg.
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 6/19 5