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Revised 4/2018
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Department
Party/Vendor Name: Orange Congregations in Mission Party/Vendor Contact Person: Robin Contact Phone: 919-
732-6194 x10 Party/Vendor Address: 300 Millstone Drive City Hillsborough State: NC Zip: 27278 Department:
Health Amount: $213,601 Purpose: Provide Zone 4 Navigator Services Budget Code(s): 10412020-630000-
71453Vendor # 65077 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check
one) New Renewal Amendment Effective Date 7/1/18 Approved by Board Yes No Agenda
Date: 5-15-18
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: B6268174-A19D-4873-8AEC-0B7ECE2FAF4C
6/21/2018
6/25/2018
6/25/2018
6/25/2018