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DocuSign Envelope ID:93FB2B9B-BEEA-484D-B662-57D5D8AA231B <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Orange Rural Fire Department Party/Vendor Contact Person: Chief Jeff Cabe Contact <br /> Phone: 919-732-7911 Party/Vendor Address: 206 S Churton St. City Hillsborough State: NC Zip: 27278 <br /> Department: Orange County Emergency Services Amount: $3,000.00 Annually Purpose: EMS Supervisor Co- <br /> location with fire department Budget Code(s): 1077520-630000 Vendor#NA (N/A if new vendor) Vendor is a <br /> BOCC consultant? Yes ❑No® Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective <br /> Date July 1,2019 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 <br /> on this project has not been initiated prior to execution of the agreement: <br /> UocuSigned by: <br /> Department Director's Signature_1[ yffilf $ Date:7/12/2019 <br /> 5655BC89iA64473. <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 <br /> was 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 /> 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 <br /> Act: L)ocusigned by: <br /> Office of the Chief Financial Officer 4 704E51S1ACC1409. � Date: 7/12/2019 <br /> Legal Services <br /> This agreement is approved as to 1 bocusigned by: ,y: <br /> Office of the County Attorney_ ` '°} - Date: 7/12/2019 <br /> 4035CB8304CA4Ae <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 <br />