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DocuSign Envelope ID: 52D13933-BEC7-4F31-890D-AD99D791A702 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Jeffrey C. West, DMD,PA Party/Vendor Contact Person: Jeffrey C. West Contact <br /> Phone: 919-636-9123 Party/Vendor Address: 601 West Rosemary Street- Ste 219 City Chapel Hill <br /> State:NC Zip: 27516 Department: Economic Development Amount: $5,000.00 Purpose: Business <br /> Investment Grant Award Budget Code(s): 34600020-900051 Vendor#N/A (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal❑ <br /> Amendment ❑ Effective Date February 12, 2016 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to techni igmdbvontent: <br /> �t $'�++x�j 2/17/2016 <br /> Department Director's Signature 1�.[=[=Ac gam,,, Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services) This agreement has been reviewed <br /> and is 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 Rqrffs-Ri�a� -s tandards, specifications, and requirements: <br /> rbV'tt,t,{{b 2/17/2016 <br /> Office of the Risk Management Officer F cFg,zsR a9a Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal <br /> Control Act: DocuSigned by: <br /> ('� 2/18/2016 <br /> Office of the Chief Financial Officer E' Date: <br /> Legal Services <br /> This agreement is approved as to 1 Pfbftff , d sufficiency: <br /> �mt,S �/V't�m& 2/18/2016 <br /> Office of the County Attorney 328DC48o549A4E5... Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All DocuSign contracts must be copied to Donna Lloyd upon completion @ <br /> Dolloydkoran eg countync.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 /> OCEDbiga July 2015 <br />