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DocuSign Envelope ID: 44838AD1 -FB18- 4721- 9FOD- 106C58252B8D <br />ORANGE COUNTY - DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Edward Larson Party/Vendor Contact Person: Edward Larson Contact Phone: (919)636-2889 <br />Party/Vendor Address: 610 Elin Court City Hillsborough State: NC Zip: 27278 Department: DEAPR- Recreation <br />Amount: $672.00 Purpose: Chess Instruction Budget Code(s): 10511020 630000 Vendor # 64469 (N /A if new <br />vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br />Amendment ❑ Effective Date Sept. 4, 2018 Approved by Board Yes❑ No® Agenda Date: <br />This agreement is approved as to to Docu5igned by: ;nt: <br />Sf.,�C 8/27/2018 <br />Department Director's Signature Date: <br />811CFA1D507A495... <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' �wu,{�a 'Docu5igned by: <br />aCis�. <br />Office of the Risk Management Officer <br />7FDCF9176800498... <br />•ds, specifications, and requirements: <br />Financial Services <br />This instrument has been pre- audited ix DocuSigned by: <br />Office of the Chief Financial Officer <br />7NE5181ACC1409... <br />This agreement is approved as tc Docu5igned by: <br />6LL Kept lfs <br />Office of the County Attorney <br />EAA3033E08A84S5... <br />Date: 8/27/2018 <br />the Local Government Budget and Fiscal Control Act: <br />Legal Services <br />iciency: <br />Clerk to the Board <br />Date: 8/28/2018 <br />Date: 8/28/2018 <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersollgorangecountwgov <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 10/17 (Mgr appry 5k 6/18) <br />2 <br />DS <br />