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DocuSign Envelope ID:9E56FE74-A7B0-4359-B3C6-OB1A7B09E573 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Rwenshaun Miller Party/Vendor Contact Person: Rwenshaun Miller Contact Phone: 919-624- <br /> 9954 Party/Vendor Address: 5002 Misty Oaks Drive, Apt. 1415 City Charlotte State: NC Zip: 8269 Department: <br /> Health Amount: $1500 Purpose: Speaker at Suicide Prevention Awareness Walk Budget Code(s): 10412020-630000- <br /> 71451 Vendor#64735 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check <br /> one) New ® Renewal ❑ Amendment ❑ Effective Date 9-1-17 Approved by Board Yes No Agenda <br /> Date: <br /> This agreement is approved as to to Dal irii b: <br /> content: <br /> On f,Vl�t 8/28/2017 <br /> Department Director's Signature 5145A2CD945C40F. Date: <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency 4MFstli e tandards, specifications, and requirements: <br /> ((USA. rblet/ut 6 <br /> 8/28/2017 <br /> Office of the Risk Management Officer 7FDCF9176800498... Date: <br /> Financial Services <br /> This instrument has been pre-audited i e4$ff`tT'8'� PPquired by the Local Government Budget and Fiscal Control Act: <br /> 6>a7, A.446,. 8/28/2017 <br /> Office of the Chief Financial Officer 7D4F5181ACC1400 Date: <br /> Legal Services <br /> This agreement is approved as t ejg$Pstli'ftai�`'d♦-sufficiency: <br /> a A. Aunt, SG6 8/28/2017 <br /> Office of the County Attorney 079&4D525COF4Fe__ 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 2/17 5 <br />