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DocuSign Envelope ID:21E45AAC-B416-4F84-9134-CAOFD22739B8 <br /> Kf?- <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Chapel Hill Moving Party/Vendor Contact Person: Ethan Smith Contact Phone: 919.929.6683 <br /> Party/Vendor Address: 7401 Rex Rd., Suite 104 City Chapel Hill State:NC Zip: 27516 Department: AMS Amount: <br /> NTE $1530 Purpose: move from 300 W Tryon & 131 W Marg Ln to Churton Grove Budget Code(s): 61370035- <br /> 880000-10068 Vendor#65179 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: <br /> (Check one) New ® Renewal ❑ Amendment ❑ Effective Date Approved by Board Yes❑ No❑ <br /> 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 /> UocuSigned by: <br /> Department Director's Signature 9� Off),40L Date: 2/26/2019 <br /> Agreements for emergency services or__r?EF373Ac❑a54EF J__t 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 standards.specifications,and requirements: <br /> Docusigned by: <br /> aUS66 ���6 <br /> Office of the Risk Management Officer Date:2/27/2019 <br /> 7FDCF9176900498. D.S <br /> Financial Services <br /> This instrument has been re-audited in the ir�-----�_-oc..S,.igned...:_by:,.a,-.`' T-)cal Government Budget Bud et and Fiscal Control Act: <br /> 1� � � <br /> Office of the Chief Financial Officer i ' a, `�' " Date: 2/28/2019 <br /> 7NE5181 ACC 1400- <br /> Legal Services <br /> This agreement is approved as to legal fora and enffu-i,-nw- <br /> UocuSigned by: <br /> Office of the County Attorney �6LW Pk�lfs Date?/28/2019 <br /> EAA3MaEMAM65.. <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 />