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,;2 Ll 7 S <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : Party/Vendor Contact Person : Contact Phone : Party/Vendor Address : <br /> City State . Zip : Department . Amount : $ 138 , 510 . 00 (Chapel Hill and Carrboro) <br /> Purpose : Interlocal Aareement with Town of Carrboro and CH for reimbursement for installati ivate sewer <br /> service lateral connections for low to moderate income Budget Code(s) : 61610007449925W 6 0007 -449926 { O <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 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 /> n <br /> Department Director ' s Signature Date : <br /> Agreements for emergency services or repair a not subject to the above affirmation . If servic relate to this <br /> agreement have already begun or been comp eted 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 Date : <br /> Financial Services <br /> This instrument has been pre - audited in the r requ ' ed by the Loc 1 Government Budget and Fiscal Control Act : <br /> Office of the Chief Financial Officer CJ" Date : 7 3 O t <br /> C <br /> Legal Services <br /> This agreement is approved as to legal form and sufficienc <br /> Office of the County Attorney JDate : �j /f <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll up n completion : smgersoll@orangecountync . gov <br /> The following signature block is for hard copies only and is of required for Docusign contracts: <br /> Office of the Clerk to the Board Date : ` <br /> r <br /> Revised 12/ 18 <br />