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Revised 06/21 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Party/Vendor Name: UNC DHS Community Practice Lab Party/Vendor Contact Person: Josephine Tetteh Contact <br />Phone: (919) 966-0910 Party/Vendor Address: 130 Mason Farm Rd City Chapel Hill State: NC Zip: 27599 <br />Department: Housing Department Amount: Twenty Thousand Dollars $20,000 Purpose: Coordination and Data <br />Management for County Home Preservation Budget Code(s): 10473020-630000 Vendor # (N/A if new <br />vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal <br />Amendment Effective Date Approved by Board Yes No Agenda Date: --- For Section XIV. <br />c. contracts only, 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 prior to execution of the agreement: <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 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 of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <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 />DocuSign Envelope ID: 88852B00-B515-4980-A36D-406A7801F515DocuSign Envelope ID: 1889ADEA-7037-4855-814E-91B512DA2CFD <br />12/20/2022 <br />DocuSign Envelope ID: 884848F6-7BD4-4D7E-9B7A-D9CB1DE8E8FC <br />1/4/2023 <br />DocuSign Envelope ID: CF924F0C-C693-4F6F-A564-DD6C6E4CD85E <br />1/6/2023 <br />DocuSign Envelope ID: B09284BC-972C-47FA-972C-5C2D2C307F99 <br />1/10/2023 <br />DocuSign Envelope ID: 1F962B08-24E5-42FB-BFF4-DCDA05446D4A