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DocuSign Envelope ID:0208AF55-755E-4EF2-9F17-9E6D613B5933 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Rvan Lavalley Party/Vendor Contact Person: Contact Phone: Party/Vendor <br /> Address: 100 Rock Haven Road,Apt 203P City Carrboro State: NC Zip: 27510 Department: Aging Amount: $4,000 <br /> Purpose: Master Aging Plan Summer Intern Budget Code(s): 10430020-630120 Vendor#63775 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date 05/09/16 Approved by Board Yes❑Nor-1 Agenda Date: <br /> This agreement is approved as to technical fgrm abed content: <br /> ocu igned Y. <br /> Department Director's Signature ,WAA*a �W Date: 5/9/2016 <br /> 67E962D1BF454FA... <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:''11i1 <br /> Office of the Risk Management Officer allSA. ('6M ,ll b Date: 7/18/2016 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner rSVuired by the Local Government Budget and Fiscal Control Act: <br /> ocuSigned <br /> Office of the Chief Financial Officer 7/20/2016 <br /> Fel�� s�oraR,�losz 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: 7/20/2016 <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.ny_c.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 />