HomeMy WebLinkAboutR 2019-038 Health - YMCA Triangle after school New Hope Elementary DocuSign Envelope ID:2AEBF8B6-5B1F-4667-AEEE-787244DBD7C8
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: YMCA of the Triangle, Inc. Party/Vendor Contact Person: Aubrey Vinson Contact Phone: 919-
442-9622 Party/Vendor Address: 980 MLK Jr. Blvd City Chapel Hill State: NC Zip: 27514 Department: Health
Amount: $2,500 Purpose: Provide an after school Y Learning_program at New Hope elementar. Budget Code(s):
10412020-630000-71453 Vendor # 52475 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No®
Contract Type: (Check one)New❑ Renewal ® Amendment ❑ Effective Date 1/16/19 Approved by Board Yes
❑No❑ Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on
this project has not been initiated prior to execution of the agreement:
OocuSigned by,
i Aan A S&Wof 1/16/2019
Department Director's Signature 3C18F2�09E3445F. Date:
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that was
addressed:
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 sufficienc- - cii5igned-a,;-`--a-rds, specifications,and requirements:
�U$66 �,DVln.t 6 1/24/2019
Office of the Risk Management Office Date:
7F6CF9178800498.
Financial Services
This instrument has been pre-audited it oocusigned by: the Local Government Budget and Fiscal Control Act:
r o 1/24/2019
Office of the Chief Financial Officer 7NE5181ACC14o9. Date:
Legal Services
This agreement is approved as t ooeusigned by:
�WAk ftA�'it, �S(b 1/24/2019
Office of the County Attorney Date:
079A4D525C0F4Fg.
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:
Revised 12/18 4