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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name : Katherine Leith Party/Vendor Contact Person : Contact Phone : Party/Vendor <br /> Address : 36 Clover Lane City Chapel Hill State : NC Zip : 27517 Departments Agin Amount : $ 4 , 000 Purpose : <br /> Senior Times Budget Code ( s) : 10430120 - 620000 Vendor # 52922 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No ® Contract Type : (Check one) New ❑ Renewal ® Amendment ❑ Effective Date <br /> 07/01 /2019 Approved by Board Yes ❑ No ❑ Agenda Date : <br /> This agreement is approved as to technical form and content : <br /> Department Director ' s Signature ._..� Date : r ' .s=/7 <br /> r"r ra. <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 atAi.. Date : ! f <br /> Arir <br /> ervices <br /> This instrument has been pre- audited in theAe the Local Government Budget and F ' cal Control Act : <br /> Office of the Chief Financial Officer Date : 2 <br /> Legal Services <br /> This agreement is approved as to legal fo nd sufficiency : <br /> Office of the County Attorney Date : <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied o Sherri Ingersoll u on completion : smgersoll a, orangecountync • gov <br /> The following signature block is for h d copi d i of required for Docusign contracts : <br /> Office of the Clerk to the Board Date : r <br /> 0 r <br /> Revised 10/ 17 (Mgr appry Sk 6/ 18 ) a�� W <br /> �- �'�/r� r , ov W (,(,hi` er <br /> h <br /> 1 �o <br /> A�n <4 t4crofna ca cop L, w exs. S <br />