HomeMy WebLinkAboutR 2019-506 Health - UNC Health Care mammogram screenings cc cp
ORANGE COUNTY—DEPARTMENT USE ONLY qo / 50 (o
Department
Party/Vendor Name : LNC Health Care System Party/Vendor Contact Person : Kathryn Grant Contact Phone : 984 -
9744274 Party/Vendor Address : 211 Friday Center Drive City Chapel Hill State : NC Zip : 27517 Department .
Health Amount : $ 8 , 000 Purpose : BCCCP Mamogram Screenings Budget Code (s) : 10414020 - 631010 -71401 Vendor
# 30892 (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 .
0 Department Director ' s Signature Date : 31 � �
Agreements for emergency services or epair 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 _ Date . i
Financial Services
This instrument has been pre - audited in the er re uired by the Local Government Budget and Fiscal Control Act :
I? I-W, I Cf
Office of the Chief Financial Officer ate :
Leal Services
This agreement is approved as to legal form and sufficiency :
Office of the County Attorney LA4,z &ft 6` �,� Date : S lTq
Clerk to the Board
Received for record retention .
All Docusign contracts must be copi to She ers 11 u on completion : singersoll@orangecountync . gov
The following signature block is for ar c onl a s of required for Docusign contracts :
Office of the Clerk to the Board Date : b
Revised 6/ 19
4