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DocuSign Envelope ID: BOB92AD3-82E9-4802-986F-D4BA45DDF1D3 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: The University of North Carolina at Chapel Hill Party/Vendor Contact Person: Diane Koltz <br /> Contact Phone: 919-962-6246 Party/Vendor Address: 123 W. Franklin St, Chapel Hill, Suite 210 City Chapel Hill <br /> State:NC Zip: 27516 Department: Social Services Amount: $6,400 Purpose:provide data to DSS to support work <br /> with measuring racial equity in the county Budget Code(s): 10460020-630000 Vendor#104919 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal❑ Amendment ❑ <br /> Effective Date 2/l/22 Approved by Board Yes❑No® Agenda Date: ---For Section XIV. c. contracts only, <br /> Approved by Board in Current FY Budget Yes❑No❑ <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 pri or t,Pe%ftVdft-of the agreement: <br /> 4/5/2022 <br /> Department Director's Signature NOUn G� CbS�b5 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 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 im rn�mgtandards,specifications,and requirements: <br /> QuSA. rbvvulib 4/5/2022 <br /> Office of the Risk Management Officer498 <br /> Date: <br /> Financial Services <br /> This instrument has been pre-audited in t' 12cqu red by the Local Government Budget and Fiscal Control Act: <br /> +� 4/6/2022 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to g TTWftWgM-sufficiency: <br /> 4/6/2022 <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 06/21 <br />