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DocuSign Envelope ID:81EB53FE-770C-4A5C-B8E5-E43BBDC488FD <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Nancy Berson, LCSW Party/Vendor Contact Person: Nancy Berson Contact Phone: 919- <br /> 360-4006 Party/Vendor Address: 109 Connor Drive, Suite 204 City Chapel Hill State: NC Zip: 27514 <br /> Department: Social Services Amount: $8,000 Purpose: individual therapy Budget Code(s): 10400220- <br /> 761005/39406020-767004 Vendor#67003 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® <br /> Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 7/l/2020 Approved by Board <br /> 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 /> ocuSigned by: <br /> Department Director's Signature[;".U�.U1 S�bin. Date: 1/22/2021 <br /> Agreements for emergency services or repair are not subject 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 sufficienc &maospaeystandards,specifications,and requirements: <br /> &A, (hnk 6 1/21/2021 <br /> Office of the Risk Management Officer e Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: cr�L� <br /> gned by: <br /> +� 1/22/2021 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as t �f �d sufficiency: <br /> 1/25/2021 <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 the Clerk upon completion: occlerkdocs@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 07/20 <br /> 9 <br />