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Revised 10/17 <br />8 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Chapel Hill Carrboro County Schools Party/Vendor Contact Person: Dr. Rydelll Harrison <br />Contact Phone: 919-967-8211 Party/Vendor Address: 750 S. Merritt Mill Road City Chapel Hill State: NC Zip: <br />27516 Department: Health Amount: $2,200 Purpose: After school acceleration program. Budget Code(s): <br />10412020-630000-71453 Vendor # 22226 (N/A if new vendor) Vendor is a BOCC consultant? Yes No <br />Contract Type: (Check one) New Renewal Amendment Effective Date 11-1-17 Approved by Board <br />Yes 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 content 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 <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 />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br /> <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 /> <br /> <br />DocuSign Envelope ID: 10A8F60A-9470-4C26-880E-45549E28A702 <br /> <br /> <br /> <br />