HomeMy WebLinkAboutR 2016-724 EMS - Durham Tech Site Affiliation Agreement DocuSign Envelope ID: FF596EF9-95C3-43F0-9E5B-F05288BBF843
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Party/Vendor Contact Person: Contact Phone: Party/Vendor Address:
City State: Zip: Department: Amount: Purpose: 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 Yes❑
Non Agenda Date:
This agreement is approved as to technical form and content:
�ivaG y vats 4/7/2016
Department Director's Signaturely".'..„R,,,,, 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:
a.Office of the Risk Management Office k �O'��#f° Date: 4/7/2016
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:
Leeal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney ” _ °'; e Date: 4/14/2016
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkoran eg countync•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:
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