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DocuSign Envelope ID:C096D0C4-21D1-4556-9576-77FCE44884E2 <br /> ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Town of Chapel Hill Party/Vendor Contact Person: Jim Orr Contact Phone: (919) 968-2785 <br /> Party/Vendor Address: 405 Martin Luther King Jr. Blvd. City Chapel Hill State: NC Zip: 27514 Department: <br /> Health Amount: $58,040 Purpose: Summer school program Budget Code(s): 10412020-630000-71453 Vendor# <br /> 64 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ NoX Contract Type: (Check one) New X <br /> Renewal❑ Amendment ❑ Effective Date 6-19-17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to texhrri @e luf mid content: <br /> Vore (ALU�Ut 7/5/2017 <br /> Department Director's Signature\---��a�azcDSaecaoF.. Date: <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 f E:1�t 'y"bsfinsurance standards,specifications, and requirements: <br /> NSA. Cort&c,ltb 7/5/2017 <br /> Office of Risk Management 7FnrF917 n4oR... Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: , ---DocuSigned by: <br /> rl A" '`°` 7/6/2017 <br /> Office of the Chief Financial Officer .......,74,4,5„,,,,,,,_,,, Date: <br /> Legal Services <br /> This agreement is approved as t P`f lilfnYi, Y�id.-.sufficiency: <br /> A. ( tl' 1 S(6 7/6/2017 <br /> Office of the County Attorney o�gnnoszscsraFe_. Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> Revised 2/17 <br />