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Contract # <br />From Munis Contract Entry <br />TOWN OF CHAPEL HILL ROUTING FORM <br /> <br /> <br /> <br /> <br /> Date Received Date Forwarded Initials <br />Department Head (Review & Approve) <br />Purchasing & Contracts Manager <br />Finance Officer (Per Budget Act) <br />Legal Review <br />Deputy/Town Manager (If Required) <br />Town Clerk (Attest, Date and Notarize) <br />Purchasing & Contracts Mgr (Distribution and Mailing) <br /> <br />Deadline for Signing: None G/L Account Number(s): <br />44007-60030 <br />Contract Dollar Amount(s): <br />Not to exceed $94,600 Special Distribution Instructions <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 <br />Contracts Office. <br /> <br />Send completed copy to Judy Johnson as well <br />Notes/Explanation <br />This if for the Historic Rogers Road Area. Sewer <br />connection permit fees, OWASA fees, and construction <br />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 />Print Form <br />Department: Planning <br />Contact Person: Judy Johnson <br />Phone Number: 919-593-0600 <br /> <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: Business Management Department <br />Return To: Zakia Alam <br />DocuSign Envelope ID: 6A765B18-7222-4240-AA94-EE24A3811D25 <br />4/18/2022 4/18/2022 <br />4/21/20224/21/2022 <br />4/22/2022 4/22/2022 <br />4/22/2022 4/22/2022 <br />4/28/20224/28/2022 <br />4/29/20224/29/2022 <br />5/5/2022 5/5/2022