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Revised 10/17 (Mgr apprv 5k 6/18) <br /> <br /> <br />4 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br /> <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Youth Empowered Solutions (YES!) Party/Vendor Contact Person: Jessica Daniels Contact <br />Phone: 404-964-5321 Party/Vendor Address: 4021 Carya Drive, Suite 160 City Raleigh State: NC Zip: 27610 <br />Department: Health Amount: $4,000 Purpose: Consultative coaching to revamp TRU Club program Budget Code(s): <br />10412020-630000-71459 Vendor # 65310 (N/A if new vendor) Vendor is a BOCC consultant? Yes No <br />Contract Type: (Check one) New Renewal Amendment Effective Date 10-1-18 Approved by Board Yes <br /> No Agenda Date: <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 conte nt and specifications: <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 the Risk Management Officer___________________________________ 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 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 />All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: 2A186D1A-DC0C-4AF3-A358-6DD18C89D561 <br />9/19/2018 <br />9/19/2018 <br />9/19/2018 <br />9/19/2018