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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Dispute Settlement Center Party/Vendor Contact Person: Andy Sachs Contact Phone: (919) <br /> 929-8800 Party/Vendor Address: 302 West Weaver St City Carrboro State:NC Zip:27510 Department: BOCC <br /> Amount: UP to$5000 Purpose: Annual Board Retreat Budget Code(s): 10200020-630000 Vendor#6127 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑No❑X Contract Type:(Check one)New❑ Renewal ❑ <br /> Amendment ❑ Effective Date Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and con nt: <br /> Department Director's Signature Date: W/ <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 /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of Risk Management A. G.p et4.� Date:_4641e <br /> Financial Services <br /> This instrument has been pre-audited in the ner fired b the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: r� <br /> Legal Services <br /> This agreement is approved as to legal form alld suffid cy: / <br /> Office of the County Attorney Date: �l ,�6 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 6/16 <br />