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DocuSign Envelope ID:6A7651318-7222-4240-AA94-EE24A3811D25 <br /> Contract# <br /> From Munis Contract Entry <br /> TOWN OF CHAPEL HILL ROUTING FORM Print Form <br /> Vendor/Contractor Name: Town of Chapel Hill/Town of Carrboro/Orange County <br /> Vendor# N/A <br /> Document Name/Title: 2022 Revised Interlocal Agreement for Private Sewer Service Lateral Connections <br /> Bid#(If applicable) N/A <br /> Department: Planning Return To: Zakia Alam <br /> Contact Person: Judy Johnson Department: Business Management Department <br /> Phone Number: 919-593-0600 <br /> Date Received Date Forwarded Initials <br /> Department Head (Review&Approve) 4/18/2022 4/18/2022 r°=„ <br /> Purchasing & Contracts Manager 4/21/2022 4/21/2022 <br /> sues <br /> Finance Officer (Per Budget Act) 4/22/2022 4/22/2022 <br /> �o <br /> Legal Review 4/22/2022 4/22/2022 <br /> Cass <br /> Deputy/Town Manager (If Required) 5/5/2022 5/5/2022 � <br /> Town Clerk (Attest, Date and Notarize) 4/28/2022 4/28/2022 5I9 <br /> Purchasing & Contracts Mgr (Distribution and Mailing) 4/29/2022 4/29/2022 <br /> Deadline for Signing: None G/L Account Number(s): Contract Dollar Amount(s): <br /> 4 <br /> Special Distribution Instructions 4007-60030 Not to exceed $94,600 <br /> Contract routing and approvals conducted through <br /> DocuSign.Once complete,a fully executed copy must be <br /> provided to the Town of Chapel Hill's Purchasing and Notes/Explanation <br /> Contracts Office. This if for the Historic Rogers Road Area. Sewer <br /> connection permit fees,OWASA fees,and construction <br /> Send completed copy to Judy Johnson as well costs for private lateral connections for residents at or <br /> below 80%AMI <br /> Vendor Mailing Address/Telephone <br /> Town of Chapel Hill <br /> 405 Martin Luther King Jr Blvd <br /> Chapel Hill, NC 27514 <br /> 919-968-2743 <br /> Form Revised 12/2017 Please do not remove form if revisions to document are necessary <br />