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ORANGE COUNTY-DEPARTMENT USE ONLY c>zo (0o -56 7 <br /> Department <br /> PartyNendor Name: James S. Pentecost Jr. PartyNendor Contact Person: Contact Phone: 1-336-503-2460 <br /> Party/Vendor Address: 4201 Woodsdale Rd. City Roxboro State: NC Zip: 27574 Department: County Manager <br /> Amount: 250 Purpose: Combread Demonstration Budget Code(s): 34600020 900057 Vendor N KSIS (N/A if <br /> new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New M Renewal ❑ <br /> Amendment ❑ Effective Date Approved by Board Yes❑ No❑ Agenda Date: , <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature �rd�' �^ Date: r' ///1f <br /> Information Technologies <br /> (Applicable only to hardware/sofnvare 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 of the Risk Management Officer 2 Date: <br /> Financial S ices <br /> This instrument has been pre-audited in the or q it by the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: I7 <br /> Legal Services <br /> This agreement is approved as to legal fore su en�c yA�� <br /> Office of the County Attorney h� Date: / 2 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersolloorangecounNnc <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 /> LF2018 v.1. <br /> 7 <br />