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02014-5�� <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: CHICLE Party/Vendor Contact Person: Contact Phone: 919-933-0398 <br /> Party/Vendor Address101 E. Weaver St., Suite G-1_ City: CarrboroState: NC Zip: 27510 Department: Health <br /> Amount: Purpose: Budget Code(s): Vendor # 43840 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑ Amendment ® Effective <br /> Date 10/17/2014 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and en <br /> Department Director's Signature Date: 1 Z <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Director of Information Technology Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requiremen <br /> Office of Risk Management ��c� _ _ Date: T 1 6 2014 <br /> Financial Services By <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer ✓ A 10L Date: <br /> t01 Ito <br /> Legal Services <br /> This agreement is approved as to legal form an sufficiency: <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br />