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DocuSign Envelope ID:463F9D68-DFE3-4C3B-91 B7-2C2231A6F350 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: TischlerBise Party/Vendor Contact Person: Carson Bise Contact Phone: 301-320-4860 <br /> Party/Vendor Address: 4701 Sangamore Rd. St. S240 City Bethseda State: MD Zip: 20816 Department: Planning <br /> &Inspections Amount: $41,500 Purpose: Payment In Lieu Budget Code(s): 10695020-720255 Vendor#56683 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New El <br /> Renewal❑ Amendment ❑ Effective Date upon execution Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to technicdkomacl content: <br /> Department Director's Signature (fail bt1th Date: 7/7/2017 <br /> '—846D 10DA3CFD4C2... <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 /> r---DocuSigned by: <br /> 'll <br /> Office of the Risk Management Officer a�1S& rbVln,tb Date: 7/7/2017 <br /> ' 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Office (1 p 4441-6-x- <br /> Date: 7/7/2017 <br /> 7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> c DocuSigned by: <br /> Office of the County Attorney ,366. Ietlitx S Date/7/2017 <br /> ' —EAA3D33ED8A8465... <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 <br /> 9 <br />