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DocuSign Envelope ID:64EBC657-51AC-4EF8-AD5C-3E50D999ACFF <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Community Empowerment Fund Party/Vendor Contact Person: Maggie West Contact Phone: <br /> (919)270-5730 Party/Vendor Address: 108 W. Rosemary City Chapel Hill State:NC Zip: 27516 Department: <br /> County Manager's Office Amount: $6,759 Purpose: Design and implementation of on public resource database <br /> "QC Connect" Budget Code(s): 32470620 680021 Vendor # (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑ No[] Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date <br /> 3/15/2016 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 jbV�ln tt � � Date: <br /> 0637994B755E477... <br /> Information Technolosies <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 insurance standards, specifications,and requirements: <br /> DocuSigned by: <br /> Office of the Risk Management Officer FllS. (,OV'htd 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 /> DocuSigned by: <br /> Office of the Chief Financial Officer Date: <br /> 7D4E5181ACC1409... <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 /> 4035CB8304CA4A9... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy(d c�orangecount.nic.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 1/16 4 <br />