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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: Lisa Baaske Contact Phone: <br />Party/Vendor Address: 405 Martin Luther King Jr Blvd City Chapel Hill State: NC Zip: 27514 Department: <br />Agin Amount: $50,000 Purpose: Senior Services Budget Code(s): 10430103 - 435001 Vendor # 64 (N /A if new <br />vendor) Vendor is a BOCC consultant? Yes ❑ No[:] Contract Type: (Check one) New ❑ Renewal <br />Amendment ❑ Effective Date 7/01/18 Approved by Board Yes❑ No❑ Agenda Date: <br />This agreement is approved as to technical form and content: <br />Department Director's Signature . GZ�X -l�GL 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 <br />Risk Management <br />Date: <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of Risk Management Date: b <br />Financial Services <br />This instrument has been pre - audited in the ner q 'red by the Local Government Budget and Fiscal Control <br />Act: <br />Office of the Chief Financial Officer Date: <br />Leal Services <br />This agreement is approved as to legal for and suf • ney: /' <br />Office of the County Attorney Date: r 7 - r <br />Clerk to the Board <br />Received for record retention: <br />Office of the Clerk to the Board Date: <br />Revised 10/17 <br />