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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Town of Chapel Hill Party/Vendor Contact Person: Bill Webster Contact Phone: <br /> Party/Vendor Ad ss: 405 Martin Luther King Jr. Blvd City Chapel Hill State: NC Zyip: 27517 Department: <br /> Aging AgjRg Amount.-,A50,000 Purpose: Senior Services Budget Code(s): 10430105-444002 endor#64 (N/A if ne <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal <br /> Amendment ❑ Effective Date 07/01/2017 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: 7-1-4-17 <br /> 0 <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 ( Date: <br /> Financial Services <br /> This instrument has been pre-audited in the r uired by the Local Government Budget and Fiscal Control <br /> Act: Vz4�7 <br /> Office of the Chief Financial Officer Date: <br /> Leal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney t��a I/&`t. / ,ta_. Date: 1 /11/1-1 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board 0L Date: <br /> Revised 2/17 <br />