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DocuSign Envelope ID:89F4F543-24CB-4190-A1B9-OB8FC1C5BCBE <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> NOT A CONTRACT EXHIBIT OR ATTACHMENT <br /> Department <br /> Party/Vendor Name: Tommy Lawrence Electrical Party/Vendor Contact Person: Warren Taylor Contact Piione: 336 <br /> 599-4771 Party/Vendor Address: P.O. Box 641 City Roxboro State:NC zip: 27573 Department: DEAPR Amount: <br /> $4,386 Purpose: Electrical service additions Budget Code(s): 61370035 880000 20026 Vendor# 30928 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 8/24/2014 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature Ah fif Date: <br /> 611CFA1D507A495... <br /> Information Technologies <br /> (Applicable only to har(hvar•e/sofht,are piru•chaves or•related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Director of Information Technology Date: <br /> Risk Manaj!emtent <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned by: <br /> Office of Risk Management Date: <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigne by: <br /> Office of the Chief Financial Officer ,;.. Date: <br /> 2 ... <br /> Lezal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the Comity Attorney Date: <br /> EAA3D33ED8A8465... <br /> Cleric to the Board <br /> Received for record retention: <br /> DocuSigned by: <br /> Office of the Clerk to the Board FDA A Date: <br /> 7E61B3FC087B4DE... <br /> Revised 7/14 4 <br />