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ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: State Employees' Credit Union Party/Vendor Contact Person: Tyretta LeCates, VP/City <br /> Officer Contact Phone:919-732-0715 Party/Vendor Address:PO Box 26807 City Ralei h State:NC Zip:27611- <br /> 6807 Department:AMS Amount:$00 Purpose:ATM Lease@a,104 E Margaret Lane Renewal Budget Code(s):N/A <br /> Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one) <br /> New❑ Renewal ® Amendment ❑ Effective Date 11/01/2015 Approved by Board Yes❑No❑ Agenda <br /> Date: <br /> This agreement is approved as to technical form and content: / <br /> Department Director's Signature ( �^" "/ Date: <br /> Inf • ation echnolo ies <br /> (Applicable only to hardware/software purchases or r ted services)This agreement has been reviewed and is <br /> approved as to information technology content and s ci tions: <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 /> Office of the Risk Management Officer e�- d r" Date:/ —4-7 h S <br /> Financial Services <br /> This instrument has been pre-audited in the er equired by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 2 7 <br /> Legal Services <br /> This agreement is approved as to legal form d icienc . <br /> 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 @ Dolloyd@orangecouptygc.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 />