HomeMy WebLinkAboutR 2019-505 Health - UNC Health Care tubal ligation services o�
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ORANGE COUNTY-=-DEPARTMENT USE ONLY---HARD COPY ONLY
Department
Party/Vendor Name : UNC Health Care System Party/Vendor Contact Person : Kathryn Grant Contact
Phone : 984 - 974 - 1274 Party/Vendor Address : 211 Friday Center Drive City Chapel Hill State : NC Zip :
27217 Department : Health Amount : $ 10 , 000 Purpose : Perform tubal ligations for uninsured women Budget
Code ( s) : 10414020 - 630000 - 71400 Vendor # 21680 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑ No ❑ Contract Type : (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7449
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 pri to execution of the agreement :
Department Director ' s Signature Lcs Date . III
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 sufficiency of insurance standards , specifications , and requirements .
Office of the Risk Management Officer C Date . Z
Financial Services
This instrument has been pre - audited in the ma er required by the Local Government Budget and Fiscal Control
Act :
Office of the Chief Financial Officer ate : ?' '
9
a
Legal Services
This agreement is approved as to legal form and sufficiency .
Office of the County Attorney . ' .Xj (�1/1 UhleyiV Date :
Clerk to the Board
Received for record retention .
All Docusign contracts must be copie She i Ingersoll upon completion : snngersoll@orangecountync . gov
The following signature block is for ar c ie o a is not required for Docusign contracts :
Office of the Clerk to the Board Date .
Oct
Revised 10/ 17
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