HomeMy WebLinkAboutR 2015-120 ES - North Carolina Emergency Management - 2015 EMPG Application Checklist for Local EM Program
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: North Carolina Emergency Management Party/Vendor Contact Person: Ricky Tuttle Contact
Phone: 919-575-4122 Party/Vendor Address: 401 Central Ave City Butner State: NC Zip: 27509 Department:
Emergency Services Amount: $35,000 Purpose: GRANT Budget Code(s): Vendor# (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ❑ Renewal
Amendment ❑ Effective Date Approved by Board No❑ Agenda Date:
This agreement is approved as to technic o co nt:
Department Director's Signature Date:
Information T o ies
(Applicable only to hardware/software pu ases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
k0frice 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:
eot�a�'y
Office of the Chief Financial Officer i y � Date: r 30 (f
Legal Services
This agreement is approved as to katnstic le enc y:
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&oranizecouMnc.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: