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DocuSign elope ID:4AAAEE04-26ED-4DC0 80 IN 1 LHNAL CONTRACT REQUISITION FORM <br /> OCUSIGN <br /> CONTRACTOR/VENDOR NAME:Orange County VENDOR#1000015376 <br /> CONTRACTOR NAME&E-MAIL(INDIVIDUAL E-SIGNING ON BEHALF OF THE CONTRACTOR): <br /> Print Name:Bonnie Hammersley,Donna Baker E-Mail Address:bhammersley2oran eg countync.gov, dbaker(a)oran eg countync.gov <br /> TYPE OF CONTRACT:New_ Renewal X Amendment X Services X Goods_ Consulting_ Construction_ Lease_Other <br /> SCOPE OF WORK:Provide Roadside Graphic Services to Orange County via Durham County Sign Shop <br /> CONTRACT AMT:Revenue NTE$25,000.00 CONTRACT TERM:July 1,2019—June 30,2020 RFP/IFB/RFQ#: N/, <br /> FUNDING SOURCE: General X State_ Federal_ UNIFORM GUIDANCE(UG)PROCEDURES APPLICABL <br /> ITEM FUND COST CENTER G/L ACCOUNT WBS ELEMENT GRANT NUMBER MATERIAL TOTAL <br /> LINE# (Grants/Projects Only) GROUP# <br /> 1 1001010000 4190485000 5200160100 0026 Revenue <br /> 2 <br /> 3 <br /> RISK MANAGER Contract Requires Risk Management Review/Approval? YES_ NO X COUNTY ATTORNEY <br /> Signature: Date: <br /> Contract Requires BOCC Approval? YES_NO X Date of BOCC Approval:1 st Approved 08/08/16 Reviewing Attorney: <br /> REQUISITIONER Ds Docusigned by: �1AGER <br /> DocuSign E-Signature: Date: 7/l/2019 Pdr. <br /> Print Name/E-Mail:Eli Nicl—mcneon, emccutcheon(&dconc.gov IL F62E9EF02D0246C. <br /> DEPARTMENT HEA DocuSigned by. CHIEF FINANCIAL OFFICER <br /> DocuSign E-Signature: Vt�b �U�1�1�`W6 Date:8/12/2019 N/A <br /> Print Name/Title:Moth _ 1622eCFAe413461 A General Services Docusign E-Signature <br /> E-Mail Address:mkeambiroiro(&dconc.gov <br /> C" Docusigned by- ryTT <br /> Additional Comments/Instructions by Department: T— h, �AAti1$ <br /> 2572�iF6761984F5 <br /> Cl DocuSigned by: <br /> -bin.1L�. �bDNIt.V' <br /> DO 35FE08CC263443F. <br /> FUNDS RESERVATION# 20-126 <br /> IS&T DEPT <br /> Purchasing Comments: Comp <br /> Docusign E-Signature <br />