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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : Town of Mebane Party/Vendor Contact Person : Chris Rollins Contact Phone : <br /> Party/Vendor Address : 106 E Washington Street City Mebane State : NC Zip : 27302 Department : Economic <br /> Development Amount : $ 1 ,452 . 75 Purpose : Article 46 Collaborative Outreach Budget Code ( s ) : 34600020 -900046 <br /> Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No ® Contract Type : (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date 12/ 16/ 19 Approved by Board Yes ❑ No ® Agenda <br /> 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 /> Department Director ' s Signature Gt Date : — / <br /> Agreements for emergency services or repair are not subject to t%deribe <br /> bove affirmation . If services related to this <br /> agreement have already begun or been completed please briefly he 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 WaDate : �� f <br /> Finaii ial S i <br /> T 10 <br /> This instrument has been pre - audited in the manner e ire y e Local Government Budget and Fiscal Control Act : <br /> Office of the Chief Financial Officer Date : �� <br /> 7 <br /> L al Services <br /> This agreement is approved as to legal form asufficiency , <br /> Office of the County Attorney Date : ZZ Zd <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 : 4� 51� ze ;?�C) <br /> Revised 12/ 18 <br />