Orange County NC Website
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<br />Revised 8/23 <br /> <br /> <br /> <br /> <br />ORANGE COUNTY—INTERNAL USE ONLY <br /> Finance Information <br />Vendor Name: Vendor Contact Person: Phone: <br />Address: City: State: Zip: <br />Department: Amount: Purpose: <br />Budget Code(s): Vendor # Vendor Status with NCSOS: <br />Vendor is a BOCC consultant: Yes No <br /> <br />Contract Details <br />Contract Type: New Amendment <br />(Original Contract: ) (Most Recent Amendment ) <br />Effective Date: End Date: <br />Notice Date: Notice Purpose: <br /> <br />Award <br />Approved by Board (Agenda Date: ); Made or Administered by <br /> <br />Signature Authority <br />- BOCC Express Delegation (Agenda Date: ) <br />- Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 <br />- Budget Policy Section XV (Capital Improvement Project: ) <br /> <br />Bidding <br />Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception (# ) <br /> <br />Department Affirmation <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project <br />has not been initiated prior to execution of the agreement. <br />Services related to this agreement have already begun or been completed. Description of the nature of the emergency condition that <br />was addressed: <br /> <br />Department Director’s Signature ____________________ Date <br /> <br />Information Technologies <br />This agreement has been reviewed and is approved as to information technology content and specifications: <br /> <br />Office of the Chief Information Officer Date: Inapplicable because no hardware/software purchases or related services <br />Risk Management <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <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 /> <br /> <br /> <br />Office of the County Attorney Date: <br />Clerk to the Board <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 />Received for record retention: <br /> <br />Office of the Clerk to the Board Date: <br />Chase Jarvis Chase Jarvis 910-388-8987 <br />115 Kiley Street Chapel Hill NC 27516 <br />Emergency Services N/A Data Use Agreement <br />N/A N/A N/A <br />10/1/2023 <br />DocuSign Envelope ID: 227BDD64-847C-455B-A779-FC60D29F0BFE <br />9/13/2023 <br />9/13/2023 <br />9/17/2023