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ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Chapel Hill Transit Party/Vendor Contact Person: Chip Hutchinson Contact Phone: 919-969- <br /> 4951 Party/Vendor Address: 405 Martin Luther King Jr. Blvd City Chapel Hill State: NC Zip: 27514 <br /> Department: Health Amount: $2,409 Purpose:_ Budget Code(s): 10410020-680030 Vendor#41530 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 9/1/17 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: Z <br /> Department Director's Signature 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 for sufficiency of insurance lstandards,specifications,and requirements: <br /> Office of Risk Management -- tT�V 1�� 'S� Date:42/—�/) 7 <br /> Financ Services <br /> This instrument has been pre-audited in the re uir d by t Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 2✓! <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney (ft efi, 1 Date: S 11 <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br /> T ` <br /> Revised 2/17 <br />