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DocuSign Envelope ID:C4A937E8-092C-4556-AF04-77BA42FA4860 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Nishith Trivedi Party/Vendor Contact Person: Nishith Trivedi Contact Phone: 757.339.9090 <br /> Party/Vendor Address: 622 Childsbere Way City Hillsborough State: NC Zip: 27278 Department: DEAPR- <br /> Recreation Amount: $4250.00 Purpose: Martial Arts and Self-Defense Instruction Budget Code(s): 10511020 <br /> 630000 Vendor# 64927 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: <br /> (Check one)New ❑ Renewal ❑ Amendment ® Effective Date March 16,2020 Approved by Board Yes❑ <br /> No® Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> q�DocuSigned by: <br /> ylawl ���r� 3/20/2020 <br /> Department Director's Signature a11CFAM5o7A495... 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 <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 sufficient, -oocusigpned by: •ds, specifications,and requirements: <br /> aUsa (per 6 3/20/2020 <br /> Office of the Risk Management Officer 7FDCF9176800498... 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: DocuSigned by: <br /> 0 3/26/2020 <br /> Office of the Chief Financial Officer 7DaE5a81ACC14a9... Date: <br /> Legal Services <br /> This agreement is approved as t DocuSigned by: iciency: <br /> �6� K6k� 3/28/2020 <br /> Office of the County Attorney EAAM3sEDSAW5... 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 11/19 LE <br />