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DocuSign Envelope ID: B673B9B3-14E3-450C-9DE2-FF2487B6D530 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: National Center for Safety Intiatives, LLC Party/Vendor Contact Person: Chris Goodman <br /> Contact Phone: 866.966.7412 Party/Vendor Address: 807 Broadway St, NE STE 300 City Minneapolis State: N1N <br /> Zip: 55413-2490 Department: Environment, Agriculture, Parks & Recreation Amount: $2070.00 Purpose: <br /> Background Checks Budget Code(s): 10511020 630000 Vendor#65490 (N/A if new vendor) Vendor is a BOCC <br /> consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 7/15/19 <br /> 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 FO aWJ sfavC Date: 7/2/2019 <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 sufficienc ems'' :"stl1aa1ndards,specifications,and requirements: <br /> Q�Sa C,brvicl�b 7/10/2019 <br /> Office of the Risk Management OfficeeeF�esoeass Date: <br /> Financial Services <br /> This instrument has been pre-audited i 1wquired by the Local Government Budget and Fiscal Control Act: <br /> 7/10/2019 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as t e Y&ffl'A•d,,��s,ufficiency: <br /> rG��►'T' 7/10/2019 <br /> Office of the County Attorney �-n33Enannd6a 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 /> Revised 12/18 4 <br /> Ds <br /> D <br />