Orange County NC Website
Browse       Search
DocuSign Envelope ID:CB76483E-567E-4F74-A6E4-OBD470778D47 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Orange County Speedway, LLC Party/Vendor Contact Person: Steve Hensley Contact <br /> Phone: 336-260-5373 Party/Vendor Address: 9740 NC-57 City Rougemont State: NC Zip: 27572 Department: <br /> Health Amount: $00 Purpose: Serve as mass vaccination site Budget Code(s): N/A Vendor# N/A (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 3/18/21 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 /> Q mk A.L1,A, �'fw� 3/18/2021 <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 <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: <br /> Information Technolouies <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 eawstandards,specifications,and requirements: <br /> QUS& cbVln.t.{fb 3/18/2021 <br /> Office of the Risk Management Office 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: DocuSigned by: <br /> �� +� � 3/20/2021 <br /> Office of the Chief Financial Officer ,DaEe,a,acc,aos Date: <br /> Legal Services <br /> This agreement is approved as to[#I"4fleA?M sufficiency: <br /> u MAVIt, �SCb 3/20/2021 <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 />