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Revised 10/17(Mgr apprv 5k 6/18)4 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Keenan A. Williams, Electrical ContractorParty/Vendor Contact Person: Keenan Williams <br />Contact Phone: 919-614-0203Party/Vendor Address: 730 Eagle Point RoadCity PittsboroState: NCZip: 27312- <br />6176Department: ITAmount: $1400.00Purpose: Electrical work prep for Video in Sheriff's office, Courthouse <br />Lobby and Jail LobbyBudget Code(s): 61370035/897208/30007Vendor # 65426(N/A if new vendor) Vendor is a <br />BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />11/12/2018Approved by Board Yes No Agenda Date: <br />This agreement is approved as to technical form and content: <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 of the Risk Management Officer___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control 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 />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 />Office of the Clerk to the Board __________________________________________Date:_________ <br />DocuSign Envelope ID: E01C0794-A545-4319-A558-3A8224933F92 <br /> <br /> <br /> <br /> <br />