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DocuSign Envelope ID: 5A99EA1D-0071-4201-A163-C6F740567B59 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: City <br /> State: Zip: Department: Amount: Purpose: Budget Code(s): Vendor# <br /> (N/A if new vendor) Vendor is a BOCC 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 technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature ri6VU[&Af, �auxw LYS Date: <br /> 0637994B755E477... <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to <br /> information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> ---DocuSigned by: <br /> Office of the Risk Management Officer rAusa, (,6V17t 6 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 /> --- +DocuSign__ed by: <br /> Office of the Chief Financial Officer INAL (� 6VL Date: <br /> 232DFFC2CFA847B... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney Date: <br /> 4035C 28304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloydLyoran ecoun nc.gov <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 September 2015 <br />