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5� <br /> 491) 19 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name : NC Forest Service Party/Vendor Contact Person : Jennifer Johnson Roach Contact Phone . <br /> 919 - 8574801 Party/Vendor Address : 1616 Mail Service Center City Raleigh State : NC Zip : 27699 - 1616 <br /> Department : DEAPR Amount : $ 147 , 134 ( County $ 58 , 854) Purpose : Forest Service Annual Contract Budget <br /> Code ( s ) : 1 0695050 - 7200 1 1 Vendor # 25374 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No ® <br /> Contract Type : (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7/ 1 /2019 Approved by Board <br /> Yes ® No ❑ Agenda Date : Via Y ov h <br /> SGJ y � � Ily <br /> /f J <br /> technical form and content and I as Department Director affirmatively This agreement is approved as to p y state work <br /> on this project has not been initiated prior to execution of the agreement : <br /> Department Director ' s Signature Date : 713 O )lel <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 . <br /> Office of the Chief Financial Officer ?.0e r- ate : <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency . <br /> Office of the County Attorney Date . / (j <br /> Clerk to the Board <br /> Received for record retention : <br /> All Docusign contracts must be copied to Sherri Ingersoll upo f eompletion : singersoll@orangecotintync . gov <br /> The following signature block is for hard copies only an s 6t required for Docusign contracts : <br /> �Office of the Clerk to the Board f�7 Date : <br /> 1 <br /> iJ <br /> Revised 12/ 18 <br />