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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : Town of Chapel Hill Party/Vendor Contact Person : Brian Litchfield Contact Phone : 919 <br /> 969 4908 Party/Vendor Address : 6900 Millhouse Road, City Chapel Hill State : NC Zip : 27516 <br /> Department : Solid Waste Amount : N/A Purpose : Use of Park & Ride Lot for Shred-A -Thon Budget Code (s) : N/A <br /> Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No ® Contract Type : ( Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date Approved by Board Yes ❑ No ® Agenda <br /> 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 /> Department Director ' s Signat 04. Date : Z � <br /> Agreements for emergency services or repair are not subject 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 /> Office of the Risk Management Officer 4D �.� � Date . 1 S <br /> t G� <br /> Financial Services <br /> This instrument has been pre - audited in them er e d by the Local Government Budget and Fiscal Control <br /> Act . <br /> Office of the Chief Financial Officer Date . f <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency , <br /> Office of the County Attorneys A44 Date : 3 / 1 S I `1 <br /> v <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 />