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55zis <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: UNCH Party/Vendor Contact Person: Chris Ellington Contact Phone: 919-966-7029 <br /> Party/Vendor Address: 101 Manning Dr City Chapel Hill State: NC Zip: 27278 Department: DSS Amount: <br /> $49,587 Purpose: The County provide UNCH the services of one full time Income Maintenance Caseworker and <br /> one part-time supervisor providing up to 10 hours of supervision a week Budget Code(s): Vendor# <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ❑ <br /> Renewal ® Amendment ❑ Effective Date 07/01/2014 Approved by Board Yes❑ No[] Agenda Date: <br /> This agreement is approved as to technical form d content: <br /> Department Director's Signature Date: <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 Chief Information Officer Date: <br /> Risk Management <br /> ���4!n <br /> This agreement is approved for sufficiency of insurance standards, specifications,and requuOffice of the Risk Management Officer � Date: <br /> Financial Services <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 �, f U[�- Date: 1 y <br /> ll n <br /> Legal Services <br /> This agreement is approved as to legal and sufficiency: <br /> Office of the County Attorney Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@oran eg countync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br />