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DocuSign Envelope ID:6066AD9F-OD78-422D-B879-352372F3B41B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Amiel Elbitar-Hartwell Party/Vendor Contact Person: Amiel Elbitar-Hartwell Contact Phone: <br /> 919-724-0268 Party/Vendor Address: 108 Scarlett Dr. Unit B City Chapel Hill State: NC Zip: 27516 Department: <br /> DEAPR-Recreation Amount: $623.00 Purpose: To Instruct Start Smart Lacrosse Budget Code(s): 10511020 630000 <br /> Vendor# 64826 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date Sept. 9,2019 Approved by Board Yes❑ No® Agenda <br /> 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: <br /> awl gga ,a 8/29/2019 <br /> Department Director's Signature 1P.,1cFA1D507A495.. 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 sufficient Docu5igneda LQ_by:. rds,specifications,and requirements: <br /> aUS 6 8/29/2019 <br /> Office of the Risk Management Office Datc: <br /> 7FDCF9178800498. <br /> Financial Services <br /> This instrument has been pre-audited ii Docusigned by: - the Local Government Budget and Fiscal Control Act: <br /> ('� � � <br /> Office of the Chief Financial Officer Date:8/30/2019 <br /> 7D4E5181ACC1400. <br /> Legal Services <br /> This agreement is approved as t DocuSigned by: iclency: <br /> ,�6�.Jn. �b�W�S 9/3/2019 <br /> Office of the County Attorney EAM D33ED8AM65.. 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 /> Cs <br />