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r <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Town of Chapel Hill Party/Vendor Contact Person: Jackie Thompson Contact Phone: 919- <br /> 969-5081 Party/Vendor Address: 405 Martin Luther King Jr Blvd City Chapel Hill State: NC Zip: 27514 <br /> Department: Aging Amount: $12,300 Purpose: Volunteer Connect Budget Code(s): 10434005-448910 Vendor# <br /> 64 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New ❑ <br /> Renewal ® Amendment ❑ Effective Date 07/01/2015 Approved by Board Yes❑ No[] Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: <br /> Information Technologies <br /> (Applicable only to hardwareIsoftware 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 /> This agreement is approved for sufficiency of insurance standards,1specifications,and requirements: <br /> Office of the Risk Management Officer e� , � (�!5� Date: 7 c <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 G' � Q/w' Date:W1.1 <br /> Legal Services <br /> This agreement is approved as to legal f an ffi iency: <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 @ DollUd@oran ecountmc• og_v <br /> The following signature block is for hard cop' on1 d is t required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br />