HomeMy WebLinkAboutR 2019-568 Health - Community Health Grant subcontract 10 ( q � 5
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ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name : UNC Department of Family Medicine Party/Vendor Contact Person : Sherry HaX Contact
9.
Phones 984-9744892 Party/Vendor Addresse 590 Manning Drive City Chapel Hill State : NC Zip : 27599
Department : Health Amount . $ 9 469 Purpose . Community Health Grant Subcontract Budget Code (s) : J 0414020 =
630000 71424 Vendor # 49882 (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 SignatureVo.,�Ov 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 :
Office of the Risk Management Officerr �' Date . l
Fin licial Services
MENEWEE
This instrument has been pre - audited in the erkuiredby the Local Government Budget a dFis al Control Act :
Office of the Chief Financial Officer Date : y
Legal Services
This agreement is approved as to legal form and sufficiency .
Office of the County Attorney (.00orku twsse& c 7i Date : Ila % I .Vi
Clerk to the Board
Received for record retention :
All Docusign contracts must be copied to Sherri Ingersoll upon completion : smgersoll@orangecountyne . 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 7/ 19 4