HomeMy WebLinkAboutR 2020-155 CJRD - UNC Dept of Psychiatry Jail services DocuSign Envelope ID: BA090480-FC7C-4753-AEF2-19BCB43C5FFB
ORANGE COUNTY-DEPARTMENT USE ONLY
Party/Vendor Name: UNC School of Medicine-Department of Psychiatry Party/Vendor Contact Person: Melisa
Campbell, Interim Associate Chair of Administration Contact Phone: 919-843-6345 Party/Vendor Address: 372
Medical School Wing D CB # 7160 City Chapel Hit l State: NC Zip: 27599-7160 Department: CJRD Amount:
$25,000 Purpose: contract psychiatry Budget Code(s): 10212020-630000 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:
P DocuSigned by:
Department Director's Signature L 1W r� Date:2/27/2020
Agreements for emergency services or repair are 27❑7sESEFC51493... 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: N/A
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:
DocuSigned by:
Office of the Risk Management Officer aUS66 (,6�6 Date:212712020
7FDCF9176900498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
DocuSigned by:
Office of the Chief Financial Officer ('1) Date:2/2 712020
7NE5181ACC1409...
Legal Services
This agreement is approved as to legal form and sufficiencv:
DocuSigned by:
Office of the County Attorney �6� K6k'6 Date:2/28/2020
EAMD33ED8AW5...
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 11/19
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