HomeMy WebLinkAboutR 2019-276 Emergency Svc - New Hope fire station agreement DocuSign Envelope ID: F6B86F27-86EF-47CD-B578-OB284AA6B90B
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: New Hope Fire Department Party/Vendor Contact Person: Chief Charles Bowden Contact
Phone: Party/Vendor Address: 4012 Whitfield Rd. City Chapel Hill State: NC Zip: 27514 Department:
Orange County Emergency Services Amount: Monthly payment for co-location of one ambulance Purpose: Co-
location Budget Code(s): 10757520-630000 Vendor# 144 (N/A if new vendor) Vendor is a BOCC consultant?
Yes ❑ No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date 04/01/19
Approved by Board Yes®Non Agenda Date: 04152014
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 ' 64agWai6 .on of the agreement:
Department Director's Signature Date:5/15/2019
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 sufficiency o WdoWeAwdards, specifications,and requirements:
a�tSa CbV'In,t,{fb 5/15/2019
Office of the Risk Management Officer uso, hVW Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
[act: DocuSigned by:
Office of the Chief Financial Officer 01. Date: 5/15/2019
Legal Services
This agreement is approved as to le & tfficiency:
Office of the County Attorney "p�\ Date: 5/15/2019
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