HomeMy WebLinkAboutR 2019-421 Aging - UNC Partnerships in Aging Ryan LaValley DocuSign Envelope ID:4409F8C2-BAB8-4DD2-B2F1-FOEE2E1BA2D6
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: UNC Partnerships in Aging Program Party/Vendor Contact Person: Contact Phone:
Party/Vendor Address: City State: Zip: Department: Aging Amount: $5, 000
Purpose: MAP Implementation on Housing Budget Code(s): 10430020-630120 Vendor # 10419 (N/A if new
vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal
Amendment ❑ Effective Date 7/1/2019 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:
h DocuSigned by:
J t - � 6/14/2019
Department Director's Signature g7E962DIBF454FA.. 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 sufficiency of insurance standards,specifications,and requirements:
WcuSiggned_by:
-
Office of the Risk Management Officer Qusa. (h4 6 Date:6/14/2019
7FDCF9176800498.
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 4 Date: 6/14/2019
704E51S1ACC1409.
Legal Services
This agreement is approved as to legal form and sufficiency:
DocuSigned by:
Office of the County Attorney *J0 flnk__ Date: 6/18/2019
4035CB8304CA4Ae
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:
4