HomeMy WebLinkAboutR 2019-536 Health - Piedmont Health Services registered dietitian services DocuSign Envelope ID:8BF3DD9B-6488-41A8-91E2-9EA5BDD974C9
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: PIEDMONT HEALTH SERVICES Party/Vendor Contact Person: ASHLEY BREWER
Contact Phone: 336-382-0242 Party/Vendor Address: 127 KINGSTON DRIVE City CHAPEL HILL State: NC
Zip: 27514 Department: HEALTH Amount: $37,290.00 Purpose: REGISTERED DIETITIAN SERVICES
Budget Code(s): 10414005-443110-71411 Vendor#27898 (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:
S�_Wof 8/6/2019
Department Director's Signature 3C16F2D09E3445F. 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 sufficienc, r ixcuSigned by: ds,specifications,and requirements:
Office of the Risk Management OfficerlluSa (h�b Date: 8/6/2019
7FDCF0176800408.
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: �o 1ACC1409.
DocuSigned by:
Office of the Chief Financial Officer � C 8/7/2019
Date:
704E51S
Legal Services
This agreement is approved as t DocuSigned by:
9"A, t, TM(h 8/7/2019
Office of the County Attorney 079A4D525COF4Fa. Date:
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 6/19
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