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DocuSign Envelope ID:A8CC6099-BBB9-4DBF-BE9D-2C2A34EF376C <br /> ORANGE COUNTY--DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Leading"To Change Party/Vendor Contact Person: Eric Rowles Contact Phone: (704)595-1789 <br /> Party/Vendor Address: 9815 Sam Furr Rd. City Huntersville State: NQ Zip: 28078 Department: Social Services <br /> Amount: 2850 Purpose: Youth Summit Training Budget Code(s): 3046020761..00071082 Vendor 4 NA (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ NoZ Contract 'Type: (Check one) New Z Renewal ❑ <br /> Amendment ❑ Effective Date 05/23/2016 Approved by Board YesD NoZ Agenda Date:NA <br /> This agreement is approved as to technical form an co iftfl tigned by: <br /> N N," 666vu 6/10/2016 <br /> k <br /> Department Director's Signature Date: <br /> Information Technolojies <br /> (Applicable only to hardwarelsoftw1are 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 insuranc ndapdop6 pecifications,and requirements: <br /> (hvvkN 6/10/2016 <br /> Office of the Risk Management Officer Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner equ4Pfl"YINl Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Lita Date: 6/10/2016 <br /> Le2al Services <br /> � <br /> o rigned ed b e b <br /> This agreement is approved.as to legal form and sufic—ie , <br /> L��� 6/10/2016 <br /> Office of the County Attorney <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Eqnro q qy <br /> q,L ggy <br /> �� E 1 L <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 <br /> Revised 1/16 4 <br /> ---------- <br />