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- 05 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : Town of Chapel Hill Party/Vendor Contact Person : Dwight Bassett Contact Phone . <br /> Party/Vendor Address : 405 Martin Luther King Jr . Blvd City Chapel Hill State : NC Zip : 27514 Department : <br /> Economic Development Amount : $ 39 , 058 . 83 Purpose : Article 46 Collaborative Outreach Budget Code (s) . <br /> 34600020 - 900046 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant ? Yes ❑ No ❑ Contract <br /> Type : ( Check one) New ❑ Renewal ❑ Amendment ❑ Effective Date 10/28 / 19 Approved by Board Yes [:] <br /> 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 /> Department Director ' s Signature %_fits ;� Date : Ile `�� — <br /> Agreements for emergency services or repair are not subject to the' ab ve affirmation . If services related to this <br /> agreement have already begun or been completed please briefly desc be 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 (loeC Date : /� g <br /> Financial Services <br /> This instrument has been pre - audited in the man r re by the Local Government Budget and Fiscal Control <br /> Act : <br /> Office of the Chief Financial Officer Date . << 1L <br /> Legal Services <br /> This agreement is approved as to legV ;777 <br /> Office of the County AttorneyDate : <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 />