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DocuSign Envelope ID:61CB4134-9DB9-47CF-99A1-E3BB1AB5177D <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Bruce Gillooly Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 346 Chatham Dr City Chapel Hill State:NC Zip: 27516 Department: Aging Amount: $2,000 Purpose: <br /> classes Budget Code(s): 10430120-629000 Vendor#51330 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No❑ Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date March 1, 2019 <br /> Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> Department Director's Signature C, JUE962D1 <br /> �io, -�� Date: 2/20/2019 <br /> Agreements for emergency servicesBF454FA.. ect to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: <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 standards,specifications,and requirements: <br /> DocuSigppned_by: <br /> . <br /> Office of the Risk Management Officer aUsa LQ 6 Date: 2/20/2019 <br /> 7FDCF9176800498. <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> Docusigned by: <br /> Office of the Chief Financial Officer 41 .4// Date?/22/2019 <br /> 704E51S1ACC1469. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney � � fay h Date: 2/22/2019 <br /> 4035CB8364CA4Ae <br /> Clerk to the Board <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 /> Office of the Clerk to the Board Date: <br /> Revised 12/18 <br /> 8 <br />