Orange County NC Website
Browse       Search
<br />DocuSign Envelope ID: A4C366A3-F5D9-473B-9218-AF49BCCA02E0 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Willis of North CarolinaParty/Vendor Contact Person: Mark A GoodeContact Phone: 704- <br />344-4867Party/Vendor Address: 214 N Tryon St, Ste 2500City CharlotteState: NCZip: 28202Department: <br />Financial Services -Risk ManagementAmount: $58,000Purpose: Insurance BrokerBudget Code(s): 10-2302-20 <br />Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes NoContract Type: (Check one) <br />NewRenewal Amendment Effective Date 12-15-2014Approved by Board YesNoAgenda <br />Date: <br />This agreement is approved as to technical form and content: <br />Department Director’s Signature <br />________________________________________ Date: ________ <br />Information Technologies <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 />Office of the Chief Information Officer________ <br />___________________________ Date: ________ <br />Risk Management <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer <br />___________________________________ 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 <br />____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney <br />__________________________________________Date: ________ <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br />Office of the Clerk to the Board <br />__________________________________________Date:_________ <br />9 <br />Revised 10/14 <br />