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DocuSign Envelope ID:5A67F2BF-9F8B-44CF-8055-05E386CCBF7B <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Nikki Giovanni Party/Vendor Contact Person: Virginia Fowler Contact Phone: 540.231.6919 <br /> Party/Vendor Address: 181, Turner St. NW City Blacksburg State: VA Zip: 24061 Department: Human Rights & <br /> Relations Amount: 3,500 Purpose: Keynote Speaker for Pauli Murray event Budget Code(s): 10460020-790005 <br /> Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New <br /> ® Renewal ❑ Amendment ❑ Effective Date Approved by Board Yes❑ No❑ Agenda Date: <br /> February 28,2021 <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 executio eunent: <br /> Department Director's Signature 444 1� Date:1/20/2021 <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 sufficiency of insurance db&eifications,and requirements: <br /> a�ISA. (hV el 6 1/20/2021 <br /> Office of the Risk Management Officer FocF9,7sso-o49a Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner re ird2P�qW Mcal Government Budget and Fiscal Control Act: <br /> fl� 0 1/21/2021 <br /> Office of the Chief Financial Officer Date: <br /> Legal Services <br /> This agreement is approved as to legal form and St fftepo"ned by: <br /> Office of the County Attorney QWV Date: 1/21/2021 <br /> ML L �S(h <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@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 07/20 4 <br />