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Revised 10/17 <br />ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Empowerment, Inc. Party/Vendor Contact Person: Delores Bailey Contact Phone: (919) <br />967-8779 Party/Vendor Address: 109 N. Graham Street # 200 City: Chapel Hill State: NC Zip: 27516 Department: <br />Housing and C/D Amount: $475,700 Purpose: Acquisition Budget Code(s): 61370035-888020-10057 - $264,400 <br />Budget Code: 61370035-889101-30003 - $211,300. Vendor # N/A (N/A if new vendor) Vendor is a BOCC <br />consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />9/5/2017 Approved by Board Yes No Agenda Date: June 6, 2017. <br /> <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br /> <br />Information Technologies <br /> <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 specificatio ns: <br /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of Risk Management_____________________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br />DocuSign Envelope ID: 764A29F1-E414-4251-9AE2-7ABF3F9D9344 <br />4/5/2018 <br />4/6/2018 <br />4/6/2018