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DocuSign Envelope ID: C0814BC9-2ADO-4479-82C0-D84B023A06E8 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Intellicom,Inc Party/Vendor Contact Person: Mike Bullock(mike @intellicomusa.com) Contact <br /> Phone: 919-957-1949 Party/Vendor Address: 2902 S. Miami Blvd., Ste C City Durham State: NC Zip: 27703 <br /> Department: AMS Amount: $2785.00 Purpose: Provide and install (3) 55" TV's and (3) lockable TV wall mounts <br /> Budget Code(s): 61370035-880000-10016 Vendor # 44533 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 5/17/2017 <br /> Approved by Board Yes❑No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> o sg y <br /> Department Director's Signature 2 74 '' Date: 5/9/2017 <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 of insurance standards, specifications,and requirements: <br /> o sg aey <br /> Office of the Risk Management Office t'sa C'1"6 Date: 5/10/2017 <br /> �71-oCT9176800s8_ <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> o sg aey: <br /> Office of the Chief Financial Office @ Date: 5/15/2017 <br /> �zn <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> �—oos�gea ey: <br /> Office of the County Attorney,9°( rOtiwts Date: 5/16/2017 <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 2/17 5 <br />