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ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Town of Chapel Hill Party/Vendor Contact Person: Bill Webster Contact Phone: 919-968- <br /> 2819 Party/Vendor Address: 200 Plant Road City Chapel Hill State: NC Zip: 27514 Department: Aging <br /> Amount: $50,000 Purpose: Seymour Center Services Budget Code(s): 10430105-444002 Vendor# 64 (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New ❑ Renewal <br /> Amendment ❑ Effective Date 07/01/2014 Approved by Board Yes[]No❑ Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature Date: �'fS <br /> Information Technologies <br /> (Applicable only to hardware/software purchases o lated services)This agreement has been reviewed and is <br /> approved as to information technology content and speci ons: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insuranc tand ds,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 <br /> Act: c� v <br /> Office of the Chief Financial Officer I '"' ' Da e: / 2 <br /> Legal Services <br /> This agreement is approved as to legal form a d su n <br /> Office of the County Attorney �. Date:�l S <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@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 />