HomeMy WebLinkAboutR 2015-194 Aging - NC Dept. of Insurance, Division of SHIIP ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: NC Dept of Insurance Division of SHIIP Party/Vendor Contact Person: Contact Phone:
Party/Vendor Address: 11 S. Boylan Ave. City Raleigh State: NC Zip: 27603 Department: Aging Amount:
$1,773.25 Purpose: SH11P Budget Code(s): 10432020 Vendor # 173 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date
10/01/20141' Approved by Board Yes❑No❑ Agenda 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 theipanner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer j00" C/�0 Date:
Legal Services
This agreement is approved as to legal form,and ufficiency:.
r ..'. ....-_L.Date:
Office of the County Attorney
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd(a-),oran eg countync.Q,tov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 10/14 4