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000wSWn Envelope ID:0r8A1513-C801-48 000AE0 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> PoUy/VuudorNumu: JV Brockwell Trucking Pad}NexdorCouinct P000u: Chuck Smith Contact Phone: (919)912- <br /> 3001 PmrtylVeudorAddoau: 8821 Old NC96 City Chapel N§K State:NC Zip:27516 Dupunmnut: DiAl�R Amount: <br /> $2,800.00 Purpose: Code(s): 10515020 630000 Vendor#42666 <br /> if new vendor) Vendor is n BUCC consultant? Yes Fl lWoM Contract Type: (Check one) New M Ruuenn| [� <br /> /\mond/nmU 0 Effective Date 5/2312016 Approved byBoard Yem[]Nom Agenda Date: <br /> ____ <br /> Thin agreement imwpprovrdnom0ochnioa| 0onnnudcmn\uN: <br /> o"cu»mned^': <br /> Department Director's Signature Bu|o:______ <br /> luformation Technologies <br /> (Applicable md),/vAm/h*m,6xqj6xnn purchases o/related services)This agreement has been reviewed and ix <br /> approved mn<ninformation technology couiuut and specifications: <br /> Office of the Chief Information Officer Iate:_____ <br /> Risk Mariageumit <br /> This agreement iu approved for sufficiency oyinaomnoostandards,specifications,and requirements: <br /> o"cumoned»,: <br /> Office of the Risk Management Oyncx Pausa, Dm<*:_______ <br /> Financial Services <br /> This instrUrnCut has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> m="mn"*»,: <br /> Office oK the Chief FtuuoolaAOfficer Date:________ <br /> Legal Services <br /> This agreement |u approved ast legal fo J sufficiencyocu D Signed by:K}�NcnoK the Comity/�ttnrmm :______ <br /> Clerk to the Board <br /> Demc|vcd for record retention: <br /> All DocuniQn contracts must bc copied to Donna Lloyd upon completion @ <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office oC the Clerk to the Board Dotu:_______ <br /> Revised 1/16 <br />