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DocuSign Envelope ID:63F8DC2B-38CC-46A3-90BF-039464DE01E5 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Edward Larson Party/Vendor Contact Person: Edward Larson Contact Phone: 919.636.2889 <br /> Party/Vendor Address: 610 Elin Court City Hillsborough State: NC Zip: 27278 Department: DEAPR-Recreation <br /> Amount: $1,696.00 Purpose: Chess Lessons and Chess Jr. and Sr. Summer Camps Instruction Budget Code(s): <br /> 10511020 630000 Vendor# 64469 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date May 16,2019 Approved by Board Yes❑ <br /> 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 /> q�DocuSigned by: <br /> yla�� Sf�.uL 6/24/2019 <br /> Department Director's Signature 611CFA1D507A495.. Date: <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, 26ocusigned ay:' ds,specifications,and requirements: <br /> Office of the Risk Management Officer QCisa (,DV1n. 6 Date:7/12/2019 <br /> 7FDCF0176800498. <br /> Financial Services <br /> This instrument has been pre-audited i Docusigned by: the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Date:7/12/2019 <br /> 7NE5181ACC1409. <br /> Legal Services <br /> This agreement is approved as tc Do cusigned by, iciency: <br /> Office of the County Attorney Date:7 12 2019 <br /> EAA3833E88A84S5.. <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 /> GS <br />