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DocuSign Envelope ID: C9EA0B0B-2780-4A41-84A0-8B172AF2D4AA <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Amiel Elbitar-Hartwell Party/Vendor Contact Person: Amiel Elbitar-Hartwel Contact Phone: <br /> 919-724-0260 Party/Vendor Address: 2701 Homestead Road Apt. 208 City Chapel Hill State: NC Zip: 27516 <br /> Department: DEAPR Amount: $567.00 Purpose: Start Smart Lacrosse Budget Code(s): 10511020 630000 Vendor# <br /> N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one) New <br /> Renewal❑ Amendment ❑ Effective Date 9/11/2017 Approved by Board Yes No Agenda Date: <br /> This agreement is approved as to to � f t f'f�YXiid content: <br /> avu# gay tt 9/9/2017 <br /> Department Director's Signature 611LEA1n5n7A4Q5_ 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 sufficienc 4 Lunt standards,specifications,and requirements: <br /> QiSa Cart e tt0 9/11/2017 <br /> Office of the Risk Management Officer 7EnCEQVRRnn4QR Date: <br /> Financial Services <br /> This instrument has been pre-audited i 42�xf dPaquired by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer � � Date: 9/11/2017 <br /> 794E54-89 ACC 1443s... <br /> Legal Services <br /> This agreement is approved as to °R Mrr sufficiency: <br /> b(UA. bt S 9/11/2017 <br /> Office of the County Attorney Date: <br /> EAAS9aa�ea6s... <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 /> r CDS <br /> s <br />