HomeMy WebLinkAboutR 2019-508 Health - UNC School of Dentistry residental dental services beo � 1r�
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ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name : LTNC School of Dentistry Party/Vendor Contact Person : Jessica Hill Contact Phone : 919 -
537 - 3513 Party/Vendor Address : CB #7450 City Chapel Hill State : NC Zip : 27599 Department : Health Amount :
$ 69 , 924 . 03 Purpose : Resident dental services Budget Code (s) : 10410120 -630000 Vendor # 36302 (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 :
Department Director ' s Signature (,1 /1 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 sufficiency of insurance standards , specifications , and requirements :
c�-
Office of the Risk Management Officer �� � Date :
Financial Services
This instrument has been pre - audited in the a quired by the Local Government Budget and Fiscal Control
Act :
Office of the Chief Financial Officer Date : Z
Legal Services
This agreement is approved as to legal form and sufficiency :
Office of the County Attorney C,/4" [,,��/(�L%t w�7rt/y - Date : 13 i `i
Clerk to the Board
Received for record retention :
All Docusign contracts must be copie o SherINngersoll tinot
completion : smgersoll@orangecountync . gov
The following signature block is for ar c i y required for Docusign contracts :
Office of the Clerk to the Board Date : v 5 1
( J'ytow, % GCS 006MG�,� Cal/
Rev . 6 19 ell