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DocuSign Envelope ID: E36B7617-9A73-4483-82EF-8ECBD677C82F <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Intellicom, Inc. Party/Vendor Contact Person: Mike Bullock (mikeg_intellicomusa.com) <br /> Contact Phone: 919.957.1949 Party/Vendor Address: 2902 S. Miami Blvd, Ste C City Durham State:NC Zip: 27703 <br /> Department: AMS Amount: $1,577.00 Purpose: Install data ports for new siemens panels for controls upgrade Budget <br /> Code(s): 61370035-800000-30018 Vendor#44533 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No <br /> ® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 9/30/19 Approved by Board <br /> 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 /> Department Director's Signatur Sf�n 91R,J{ Date: 9/25/2019 <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: N/A <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 Office �,, WLVW Date:9/25/2019 <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards, specifications,and requirements: <br /> Office of the Risk Management Office l s'bn1t f° Date:9/25/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> PL <br /> Office of the Chief Financial Officer Date:9/26/2019 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney �' ` ° Date: 9/26/2019 <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 />