R 2016-688-E Health - CHCCS to provide afterschool tutoring to Northside Elem. students

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DocuSign Envelope ID:E4E01E48-2996-4D82-BC63-CF23EF83259D ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Chapel Hill Carrboro County Schools Party/Vendor Contact Person: Dr. Rydell Harrison Contact Phone: 919-967-8211 Party/Vendor Address: 750 S. Merritt Mill Rd. City Chapel Hill State: NC Zip: 27516 Department: Health Amount: $2,484 Purpose: Provide an after school tutoring program to Northside Elementary students Budget Code(s): 10412020-630000-71453 Vendor # 22226 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 12/1/16 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to to /f L3aM Wd content: IN 12/2/2016 Department Director's Signature e �F Date: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency, j�� migzb,.tanndards, specifications, and requirements: a�iSa rbvvutl6 12/2/2016 Office of the Risk Management Officer FDC Date: Financial Services DocuSi ned b This instrument has been pre-audited i the manner equired by the Local Government Budget and Fiscal Control Act: ('q-m 0°"�— 12/2/2016 Office of the Chief Financial Officer M4E5181ACC1409... Date: Legal Services This agreement is approved as t e 'YV?fi�d�ivid sufficiency: -��- 1Z/Z/2016 Office of the County Attorney ao35cBaaoacAl— Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dollo d&oran etync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 6/16 5