HomeMy WebLinkAboutR 2019-507 Health - UNC Family Medicine Medical Director services i.
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ORANGE COUNTY-DEPARTMENT USE ONLY
1 a
Party/Vendor Name : UNC Family Medicine Party/Vendor Contact Person : Pam Hoover Contact Phone : 984 - 974 -
4890 Party/Vendor Address : 590 Manning Drive City Chapel Hill State . NC Zip : 27599 Department : Health
Amount : $ 167 ,217 . 50 Purpose : Medical Director Services for Clinic Budget Code (s) : 10414020 - 630000 -
71400 /71403 /71406/71408 /71409 /71414 /71416/71418 Vendor # 21243 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No ® Contract Type : (Check one) New ❑ Renewal ® Amendment ElEffective Date 7 -
149 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 :
Department Director ' s Signature IJILn LJ Date :
Agreements for emergency services or re air 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 : 1 �
Financial Services
This instrument has been pre - audited in the er required by the Local Government Budget and Fiscal Control
Act .
Office of the Chief Financial Officer Date : g zI
Legal Services
This agreement is approved as to legal form and sufficiency .
Office of the County Attorney 4 ,4 �� � !`" Date .
Clerk to the Board
Received for record retention :
All Docusign contracts must be copie t She gersolI pon completion : singersoll@orangecountync . gov
The following signature block is for ar c s a d s t equired for Docusign contracts :
Office of the Clerk to th Board 6 0j!! Date : O O
Revised 12/ 18