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DocuSign Envelope ID: DB07BCBB-97D7-4769-AF8A-905711BEFAD9 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Chapel Hill-Carrboro YMCA-Boomerang Party/Vendor Contact Person: Tami Pfeifer Contact <br /> Phone: 919-968-2146 Party/Vendor Address: 825-A North Estes Drive City Chapel Hill State: NC Zip: 27516 <br /> Department: Health Amount: $10.000 Purpose: Program support resources for Boomerang to provide services to <br /> students living in or attending a zone school. Budget Code(s): 10412020-681000-71453 Vendor#800057 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 1-1-2016 Approved by Board Yes F]No❑ Agenda Date: <br /> This agreement is approved as to to n cliff&& f$�YYi,d1,A,c ment: <br /> Imo` 4/12/2016 UkVA� <br /> Department Director's Signature�QF�oonF�s�s�s-. Date: <br /> Information Technolosies <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 /> This agreement is approved for sufficient I� ®rstandards, specifications,and requirements: <br /> QUSA, (hVVt 6 4/12/2016 <br /> Office of the Risk Management Officer ,,s,,,-7-,,,,4, Date: <br /> Financial Services <br /> This instrument has been pre-audited i gft8fYWVftquired by the Local Government Budget and Fiscal Control Act: <br /> a€�asa Teo. <br /> Office of the Chief Financial Officer <br /> i t a Date: 4/15/2016 <br /> .. <br /> Legal Services <br /> This agreement is approved as t eg°a4`l'b"'ffiYd sufficiency: <br /> Office of the County Attorney Date: 4/15/2016 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.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 /> Revised 1/16 4 <br />