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Revised 10/17 6 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br /> <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Intellicom, Inc. Party/Vendor Contact Person: Mike Bullock (mike@intellicomusa.com) <br />Contact Phone: 919.957.1949 Party/Vendor Address: 2902 S. Miami Blvd Ste C City Durham State: NC Zip: <br />27703 Department: AMS Amount: $25,000.00 Purpose: Data/fiber for Sportsplex Field House Budget Code(s): <br />54540030-880000 Vendor # 44533 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract <br />Type: (Check one) New Renewal Amendment Effective Date 8/31/18 Approved by Board Yes No <br /> Agenda Date: <br /> <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br /> <br />Asset Management <br /> <br />(Applicable only to construction contracts) This agreement has been reviewed and is approved as to construction <br />services content and specifications: <br /> <br />Office of the Asset Management Director__________________________________ Date: ________ <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer ___________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <br />Received for record retention: <br />All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: 7E9FF784-5580-4F4F-95AD-AAF601ED7565 <br /> <br /> <br /> <br /> <br />