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DocuSign Envelope ID: EAD61387-EOF3-42A1-B144-F5D636C155C1 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Nishith Trivedi Party/Vendor Contact Person: Nishith Trivedi Contact Phone: 757-339-9090 <br /> Party/Vendor Address: 622 Childsberg Way City Hillsborough State: NC Zip: 27278 Department: DEAPR- <br /> Recreation Amount: $3,000 Purpose: To instruct Mixed Martial Arts and Adult Self-Defense Budget Code(s): <br /> 10511020 630000 Vendor# 64927 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 7/24/2019 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 /> CP.1 <br /> DocuSigned by: <br /> a l goLa 7/30/2019 <br /> Department Director's Signature 1 CFA1D5o7A4s5.. 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 sufficiency 'Docusigned_by: <br /> . ' is,specifications,and requirements: <br /> �USX �,DVln.fr��b 7/31/2019 <br /> Office of the Risk Management Officer 7FDCF9170900498. Datc: <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 I 41.&1. Date:8/2/2019 <br /> 7NE5181ACC1400- <br /> Le2al Services <br /> This agreement is approved as t DocuSigned by, iciency: <br /> �bLW K6�tk�s 8/2/2019 <br /> Office of the County Attorney EAA3D33ED8AM65.. 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 />