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DocuSign Envelope ID:CDA66E87-89C6-4C1 E-8E67-21 DAE5504845 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Keenan Williams Party/Vendor Contact Person: Keenan Williams Contact Phone: 9196140203 <br /> Party/Vendor Address: 730 EAGLE POINT City PITTSBORO State: NC Zip: 27312 Department: CSS Amount: <br /> 380.00 Purpose: Electrical Budget Code(s): 10-30-440-630000 Vendor#42313 (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date <br /> 01/25/19 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> Department Director's Signature F gv"4 Date: 1/24/2019 <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that was <br /> addressed: <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 softdavdiwompctoifications,and requirements: <br /> Office of the Risk Management Officer LIUS0, C,bV1n,t,{}b cF�U�soaa�� Date: 2/7/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner req ' "+sflf�P cal Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date:2/7/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and suffici 7pocuSigned by: <br /> bl�, <br /> ^ � I�otiwfS <br /> Office of the County Attorney J 3u3 Date: 2/7/2019 <br /> E,� <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 /> Revised 12/18 4 <br />