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<br />DocuSign Envelope ID: 32BC68D8-902B-48C6-88B0-61B93820643E <br />ORANGE COUNTYDEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Margie Bocceri Party/Vendor Contact Person: Margie Bocceri Contact Phone: (919) 593-3165 <br />Party/Vendor Address: 2114 Copeland Way City Chapel Hill State: NC Zip: 27517 Department: Health Amount: <br />2,000 Purpose: Afordable Care Act Counselor Budget Code(s): 10414020-630000 Vendor # N/A (N/A if new <br />vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal <br />Amendment Effective Date 11/13/14 Approved by Board Yes No Agenda Date: <br /> <br />This agreement is approved as to technical form and content: <br /> <br /> ________________________________________ Date: ________ <br /> <br /> <br />Information Technologies <br /> <br />Applicable only to hardware/software purchases or related services <br />() This agreement has been reviewed and is <br />approved as to information technology content and specifications: <br /> <br />Office of the Chief Information Officer________ <br />___________________________ Date: ________ <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer <br />___________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> <br />Office of the Chief Financial Officer <br /> ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney <br />__________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br /> <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br /> <br />Office of the Clerk to the Board <br /> __________________________________________Date:_________ <br /> <br /> <br />5 <br />Revised 10/14 <br /> <br />