HomeMy WebLinkAboutR 2014-608 Finance - Willis of North Carolina, Inc. for Insurance Broker (Risk Management)
DocuSign Envelope ID: A4C366A3-F5D9-473B-9218-AF49BCCA02E0
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Willis of North CarolinaParty/Vendor Contact Person: Mark A GoodeContact Phone: 704-
344-4867Party/Vendor Address: 214 N Tryon St, Ste 2500City CharlotteState: NCZip: 28202Department:
Financial Services -Risk ManagementAmount: $58,000Purpose: Insurance BrokerBudget Code(s): 10-2302-20
Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes NoContract Type: (Check one)
NewRenewal Amendment Effective Date 12-15-2014Approved by Board YesNoAgenda
Date:
This agreement is approved as to technical form and content:
Department Director’s Signature
________________________________________ Date: ________
Information Technologies
Applicable only to hardware/software purchases or related services
() This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer________
___________________________ Date: ________
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer
___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act:
Office of the Chief Financial Officer
____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney
__________________________________________Date: ________
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board
__________________________________________Date:_________
9
Revised 10/14