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Revised 5/2016
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Chapel Hill Carrboro City SchoolsParty/Vendor Contact Person: Todd LoFrese Contact Phone:
919-967-8211 x 28228 Party/Vendor Address: 750 S. Merritt Mill Road City Chapel Hill State: NC Zip: 27516
Department: Health Amount: $45,540 Purpose: Provide Summer K-Readiness program Budget Code(s): 10412020-
630000-71453 Vendor # 22226 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract
Type: (Check one) New Renewal X Amendment Effective Date 4/1/18 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 Sherri Ingersoll upon completion: singersoll@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: 86ED9E86-0054-49E9-91B7-3DBBDF219DB4
4/27/2018
4/28/2018
4/30/2018
4/30/2018