HomeMy WebLinkAboutR 2019-414 Health - Chatham County Health Dept health services DocuSign Envelope ID:081C06CA-1640-444A-8371-6 FEB B2DO11DF
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: Chatham County Public Health Department Party/Vendor Contact Person: Tara Gregory
Contact Phone: 919-742-5641 x 8266 Party/Vendor Address: 1000 S. 1 Oth Ave. City Siler Ci State:NC Zip: 27344
Department: Health Amount: $2,250 Purpose: Replication of CHG voucher program Budget Code(s): 10414020-
680007-71424 Vendor#51966 (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:
Department Director's Signature Sb�wakf Date: 7/3/2019
3C16F2D09E344IF.
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 sufficient oocuSiggned by: rds,specifications,and requirements:
Qusa. (h4 6 7/3/2019
Office of the Risk Management Office 7FDCF9176800498 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 rq � � Date: 7/4/2019
7NE5181ACC1409. — -
Legal Services
This agreement is approved as tc11079A4D525C0F4FB
Docusigned by:
S�
Office of the County AttorneyKAZ AAkYt, Date: 7/8/2019
.
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 4