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DocuSign Envelope ID:9786A36A-88C6-45C6-8299-B927DCBC8AFC <br /> NEGLIGENCE OR INTENTIONAL MISCONDUCT OF SELERIX OR THE VIOLATION OF THESE TERMS <br /> AND CONDITIONS BY SELERIX. <br /> G. Any notice or approval required or permitted under this Agreement to be sent to either party shall <br /> be sent to such party as required by the notice requirements set forth in the Subscription Agreement <br /> SUBSCRIBER has with SELERIX. <br /> H. By executing this Agreement SELERIX affirms that SELERIX is and shall remain in compliance <br /> with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement SELERIX <br /> certifies that SELERIX has not been identified, and has not utilized the services of any agent or <br /> subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. <br /> I. This Agreement together with any amendments or modifications may be executed electronically. <br /> All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and <br /> Article 40 of North Carolina General Statute Chapter 66. <br /> SUBSCRIBER and the individual(s) acknowledging receipt of and acceptance of these terms and <br /> conditions represents that each such individual is a duly authorized representative of SUBSCRIBER. <br /> By signing below, the undersigned SUBSCRIBER acknowledges its receipt and acceptance of the <br /> foregoing terms and conditions. <br /> Orange County SELERIX SYSTEMS, INC. <br /> DocuSigned by: DocuSigned by: <br /> l r i ttA,Wic, hAmt-rs(,t,1 1,11(A. Gln(-61A, <br /> Signed: <br /> ll <br /> 0637-99 4D7aC477 833BBOf27 -.':e... i? <br /> Print name: Bonnie Hammersley Lyle Griffin <br /> Title: County Manager President <br /> Date: 11/18/2016 11/11/2016 <br /> NOTE: PLEASE VERIFY SECTION 3) SUBSCRIBER SERVICE ELECTIONS <br /> HAS BEEN COMPLETED. <br /> EMPLOYER'S ADDRESS FOR NOTICES: <br /> Orange County, North Carolina <br /> 200 South Cameron Street <br /> Hillsborough, NC 27278 <br /> ACA FILING TERMS AND CONDITIONS AMENDMENT <br /> PAGE 3 <br />