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c;2el 7 Dg <br /> DocuSign Envelope ID : 39F189E1 - B1A8-45CA-A1D5 -49794CO2CC7D <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name : Town of Chapel Hill Party/Vendor Contact Person : Brian Litchfield Contact Phone : 919 - <br /> 9694908 Party/Vendor Address : 6900 Millhouse Rd City Chapel Hill State : NC Zip : 27516 Department : Solid <br /> Waste Amount : N/A Purpose : Use of Park and Ride Lot for shred a thon Budget Code ( s ) : N/A Vendor # <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No ❑ Contract Type : (Check one) New <br /> 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 <br /> on this project has not been initiated prior to execution of the agreement : <br /> DocuSigned by: <br /> Department Director ' s Signature Date : 10 / 7 / 2019 <br /> Agreements for emergency services or ' am4w4oaubject 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 /> DocuSigned by: <br /> "" �� <br /> Office of the Risk Management OfficerFaus. VIAkltb Date : 10 / 7 / 2019 <br /> 7FDCF9176800498. 11 <br /> Financial Services <br /> This instrument has been pre - audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act : <br /> DocuSigned by: <br /> (Office of the Chief Financial Officer Date : 10 / 7 / 2019'� ���� <br /> 7D4E5181ACC1409 . 11 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency : <br /> DocuSigned by: <br /> Office of the County Attorney F9KkLG NWit, 1�6SCb Date : 10 / 7 / 2019 <br /> 079A4D525COF4FBI . . <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 /> � ^ / <br /> Office of the Clerk to the Board Date : l �n/ <br /> Revised 12/ 18 <br />