Orange County NC Website
DocuSign Envelope ID:5C7208B6-A7C4-4B46-9DB4-28BA397150B2 <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: $1,008.00 Purpose: Chess Instruction Budget Code(s): 10511020 630000 Vendor # 64469 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date Sept. 12,2019 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 on <br /> this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: r <br /> Department Director's Signature1P611r-FA1D507A405. <br /> awl �f� � Date8/28/2019 <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 -Diocusigned by: 'ds, specifications,and requirements: <br /> aUsa ( Q� 6 8/28/2019 <br /> Office of the Risk Management Officer 7FDCF9176800498. Date: <br /> Financial Services <br /> This instrument has been pre-audited it ' DocuSigned by: ' '' the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer Ir <br /> 4 � Date8/30/2019 <br /> 7D4E5181ACC1409. <br /> Legal Services <br /> This agreement is approved as t DocuSigned by: :iciency: <br /> �6� �6�t4 5 9/3/2019 <br /> Office of the County Attorney EAA3D33EDSA84s5.. 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 /> P Ds <br /> CS <br />