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Revised 11/19 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Party/Vendor Name: Dispute Settlement Center Party/Vendor Contact Person: Frances Henderson Contact Phone: 919-929-8800 <br />ext. 11 Party/Vendor Address: 302 West Weaver Street #A City Carrboro State: NC Zip: 27510 Department: Finance and <br />Administrative Services Amount: 2019-540E Original Contract Max Amount $6,500 – Amendment to Max. $7,200 Purpose: 2019- <br />540E Intergovernmental Collaboration Facilitation Services Budget Code(s): 10395020-720152 Vendor # 6127 (N/A if new vendor) <br />Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />12/1/2019 Approved by Board Yes No Agenda Date: 6/18/2019 <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has <br />not been initiated prior to execution of the agreement: <br />Department Director’s Signature ________________________________________ Date: ________ <br />Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have <br />already begun or been completed please briefly describe the nature of the emergency condition that was addressed: n/a <br />Information Technologies <br />(Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is approved as to <br />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 manner required by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and 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 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 />DocuSign Envelope ID: D7170807-B94E-4228-8DB1-31F49D55977E <br /> <br /> <br /> <br /> <br />