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DocuSign Envelope ID: F6B86F27-86EF-47CD-B578-OB284AA6B90B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: New Hope Fire Department Party/Vendor Contact Person: Chief Charles Bowden Contact <br /> Phone: Party/Vendor Address: 4012 Whitfield Rd. City Chapel Hill State: NC Zip: 27514 Department: <br /> Orange County Emergency Services Amount: Monthly payment for co-location of one ambulance Purpose: Co- <br /> location Budget Code(s): 10757520-630000 Vendor# 144 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 04/01/19 <br /> Approved by Board Yes®Non Agenda Date: 04152014 <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 ' 64agWai6 .on of the agreement: <br /> Department Director's Signature Date:5/15/2019 <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 o WdoWeAwdards, specifications,and requirements: <br /> a�tSa CbV'In,t,{fb 5/15/2019 <br /> Office of the Risk Management Officer uso, hVW Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> [act: DocuSigned by: <br /> Office of the Chief Financial Officer 01. Date: 5/15/2019 <br /> Legal Services <br /> This agreement is approved as to le & tfficiency: <br /> Office of the County Attorney "p�\ Date: 5/15/2019 <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 />