HomeMy WebLinkAboutR 2018-012 Risk Management - Willis of NC Insurance BrokerageRevised 10/17 9
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Willis of North Carolina Party/Vendor Contact Person: Mark Goode Contact Phone: 704-
344-4867 Party/Vendor Address: 214 N. Tryon Street City Charlotte State: NC Zip: 28202 Department: Risk
Management Amount: $54,500.00 Purpose: Insurance Brokerage Budget Code(s): 10230220 641015 Vendor #
62936 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New
Renewal Amendment Effective Date 12/1/17 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 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:_________
DocuSign Envelope ID: AAB342A1-84D6-4FD9-BC12-585C2F446C71
1/10/2018
1/11/2018
1/11/2018
1/11/2018