Orange County NC Website
Browse       Search
DocuSign Envelope ID:56DO8A7F-OCDB-4460-8C66-9871979EC92C <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Kevin Kirk Party/Vendor Contact Person: Kevin Kirk Contact Phone: 919-419-0171 <br /> Party/Vendor Address: 5311 Beaumont Drive City Durham State:NC Zip: 27707 Department: Health Amount: 600 <br /> Purpose: Group instruction for DSME program Budget Code(s): 10414020-630000-71405 Vendor# 34783 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal <br /> Amendment ❑ Effective Date 7-1-19 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 on <br /> this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> AInG� S�_Wof 7/3/2019 <br /> Department Director's Signature 5F. Date: <br /> 3C16F2D09E344 <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 was <br /> 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 sufficient DocuSigned by: rds, specifications,and requirements: <br /> aUS66 �,bVln.f,{�6 7/8/2019 <br /> Office of the Risk Management Office 7FDCF9176800498. Date: <br /> Financial Services <br /> This instrument has been pre-audited itIr7NE5181AMA00 <br /> DocuSigned by: the Local Government Budget and Fiscal Control Act: <br /> 4 � 7/8/2019 <br /> Office of the Chief Financial Officer . Date: <br /> Legal Services <br /> This agreement is approved as t DocuSigned by: {� <br /> "k f' l�S(h 7/8/2019 <br /> Office of the County Attorney o79A4D525COF4FB. Date: <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 4 <br />