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DocuSign Envelope ID: 9700507C-F8DD-4D99-B4F2-ADC24286F4B8 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Scott Haider Electric Party/Vendor Contact Person: Scott Haigler Contact Phone: 919-479- <br /> 9550 Party/Vendor Address: 6616 Blalock Rd City Bahama State: NC Zip: 27503 Department: Emergency Services <br /> Amount: 4500.00 Purpose: Electric outlets for Situation Monitors Budget Codes): 10750020-570001 Vendor 4 62639 <br /> (NIA if new vendor) Vendor is a B GCC consultant`? Yes ❑ No® Contract Type: (Check one) New ® Renewal <br /> ❑ Amendment ❑ Effective Date Approved by Board Yes[] No[] Agenda Date: <br /> This agreement is approved as to tec bC iiaraad:content: <br /> � <br /> �^' �'�`� <br /> Department Director's Signature Date. 5/11/215 <br /> EAF7SFFEC4-A ... <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of' n0miWards, specifications, and requirements: <br /> Office of the Risk Management Officer Date: 5/13/2015 <br /> Financial Services <br /> This instrument has been pre-audited in nor"aired by the Local Government Budget and Fiscal Control Act: <br /> PMAL 5 2 5 2 015 <br /> Office of the Chef Financial Officer Date. / / <br /> Leal Services <br /> This agreement is approved as to aMf�y,� -sufficiency: <br /> �66kw ups 5 26 2015 <br /> I I Office of the County Attorney . Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion 4 Dolloyd(dwm-i ecoujtync. <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10114 4 <br />