Orange County NC Website
Browse       Search
Revised 10/17 <br />ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Party/Vendor Contact Person: Contact Phone: Party/Vendor Address: <br />City State: Zip: Department: Amount: Purpose: Budget <br />Code(s): Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract <br />Type: (Check one) New Renewal Amendment Effective Date Approved by Board Yes No <br /> Agenda Date: <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ 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 of insurance standards, specifications, and requirements: <br />Office ofRisk Management _____________________________________________ Date: _________ <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 />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <br />Clerk to the Board <br />Received for record retention: <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />S.Solutions I <br />5000BlueCla <br />ToddRadaba 910-386-8522 <br />CastleHayne NC28429CJRD Upto$5,000MDPprogram <br />10212010-72 65041 <br />4/4/18 <br />DocuSign Envelope ID: 2042AF9E-4D4F-4C48-9CFC-6BAF31AB811D <br /> <br /> <br /> <br />