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DocuSign Envelope ID:Al62B0D1-AC30-4C85-B533-0C40F1Al9433 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: David Hesselmeyer dba On Target Preparedness Party/Vendor Contact Person: David <br /> Hesselmeyer Contact Phone: 910-214-4086 Party/Vendor Address: 266 Braddock Drive City Lillington State: NC <br /> Zip: 27546 Department: Health Amount: $4,000 Purpose: Assist Preparedness Coordinator with fullfilling state <br /> addendum requirements Budget Code(s): 10412020-630000-71413 Vendor#63291 (N/A if new vendor) Vendor is <br /> a BOCC consultant? Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective <br /> Date 1/15/17 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to n aaid, nt: <br /> (� 1/24/2017 <br /> Department Director's Signature c9ED9DOFCiB545E... Date: <br /> Information Technologies <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 4fisatW '_�vstandards,specifications,and requirements: <br /> aMtSA. rbvvutl6 1/24/2017 <br /> Office of the Risk Management Officer 7FDCF917e800408 Date: <br /> Financial Services <br /> This instrument has been pre-audited i t eVi e`rbFequired by the Local Government Budget and Fiscal Control Act: <br /> � p ` n '`°` 1/24/2017 <br /> Office of the Chief Financial Officer 7D4E5181ACC1409... Date: <br /> Legal Services <br /> This agreement is approved as tq(IggRPGItbsiWaPX:1 sufficiency: <br /> 1/24/2017 <br /> Office of the County Attorney \--4035CB8304CA4Ae... Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.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 6/16 5 <br />