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DocuSign Envelope ID:2FC19A31-7154-43E6-89A2-A0B1 CCA5DD4D <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Juliet Sheridan Party/Vendor Contact Person: Juliet Sheridan Contact Phone: 803-622-6812 <br /> Party/Vendor Address: 400 Davie,Rd,#47 City Carrboro State:NC Zip: 27510 Department: Health Amount: $1,700 <br /> Purpose: Design/produce GIS Health maps Budget Code(s): 10410020-630000 Vendor# 63501 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date 12/1/2015 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to to ' X71 d content: <br /> i tt,,, Pa-'--o. 12/3/2015 <br /> Department Director's Signature cs�eseo= sa6E Date: <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 sufficient IEivsfitu 'standards, specifications,and requirements: <br /> QUSL Corti ,t16 12/8/2015 <br /> Office of the Risk Management Officer 7RDCF917RR0049R_ Date: <br /> Financial Services <br /> This instrument has been pre-audited i e 4fFkii'� it quired by the Local Government Budget and Fiscal Control Act: <br /> , 0,..., ,,.. 12/8/2015 <br /> Office of the Chief Financial Officer 4FS,R1 Acc,4o9 Date: <br /> Legal Services <br /> This agreement is approved as t ,i1146ttrrittld sufficiency: <br /> -(4,- <br /> Office of the County Attorney 1035ce8304cA4 Date: 12/15/2015 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.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 10/14 4 <br />