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DocuSign Envelope ID: D37C6C9E-3CC6-4586-B782-34070527DC90 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department: <br /> Party/Vendor Name: NC Depprtment of Insurance Party/Vendor Contact Person: R Van Braxton Contact Phone: < <br /> 919-807-6900 Party/Vendor Address: SHI1P Divislon, 1 1,5. Boylan Ave City Raleigh State: N.c. Lip: 27603 <br /> Department: Aging Amount: $42101 Purpose: Senior Health Insurance Information Program Budget Code(s): <br /> 10432005-444104 Vendor# 173 (N/A if new vendor) Vendor is a BOCC consultant? Yes Li No Contract <br /> Type: (Check one)New El Renewal Z Amendment El Effective Date Q7191/15 Approved by Board Yes0 <br /> Nop Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature tlita <br /> C <br /> 9a <br /> B7Ege2D1BF454 FA ,,,,: 11/30 <br /> J tv _ /2015 <br /> _...................... „ <br /> Information Technologies, <br /> (Applicable only to hardwarelsgfiware 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 /> k <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications, and requirements: <br /> ,.—DocuSigned by: <br /> Office of the Risk Management Officer aGS6t CIA/IA-Ali-6 <br /> 7FDCFg176800498 Date: 12/1/2015 <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 /> DocuSigned by: <br /> Office of the Chief Financial Officer,., rq"-N 4,1-41.14.•0- <br /> r <br /> 7D4E5181ACC1409 Date: 12/14/2015 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office OA ce of the County Attorney -, , 1 <br /> inkt,__ <br /> 4035C B8304CA4AG Date:,12/14/2015 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion ce.i: DAJoyd@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 Date: _ <br />