Orange County NC Website
Revised 12/18 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br /> <br />Party/Vendor Name: Circulation, Inc. Party/Vendor Contact Person: Chelsea Lawson Contact Phone: 215-317- <br />2965 Party/Vendor Address: 53 State Street 2nd Floor City Boston State: MA Zip: 02109 Department: Health <br />Amount: $5,500 Purpose: Provide transportation to Maternal Health and CHG clients to attend appointments <br />Budget Code(s): 10414020-630000-71424/71409 Vendor # 65642 (N/A if new vendor) Vendor is a BOCC <br />consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 5- <br />13-20 Approved by Board Yes No Agenda Date: <br /> <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 /> <br /> <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: Forgot to do an amendment back in May. <br /> <br />Information Technologies <br /> <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 /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: 1D5463B5-2F1B-4D85-8313-13B442A5B458 <br />9/1/2020 <br />9/2/2020 <br />9/2/2020 <br />9/3/2020