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DocuSign Envelope ID:5EDEB981-591E-4B40-919A-DCDA565AD550 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/VencJQj Name: C ass USA Ply/Vendor Contact Person: Amy MckeP Co9ct on�919-225-9338 <br /> Party/Ven Address:l Camden Ave City Durham State: NC Zip: 27704 Departm A Amount <br /> Purpose:Vending Machine Setup at 405 Meadowlands Dr Budget Code(s): Vendor# 54356 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes No X Contract Type:(Check one)New X Renewal Amendment Effective <br /> Date Approved by Board 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 p ' Dt&, "on of the agreement: <br /> Department Director's Signatur SIB QVIn, Date: 12/20/2020 <br /> Agreements for emergency services or' WI apse 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 Di astlga :standards,specifications,and requirements: <br /> C,bvv�,e.11b 12/29/2020 <br /> Office of the Risk Management Office ±Uso-rser-s1,�aoex5 Date: <br /> DS <br /> Financial Services <br /> This instrument has been pre-audited' g,�% required by the Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Offic 4"� 0"�� Date: 12/30/2020 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as ogoDsfpmpnd sufficiency: <br /> Office of the County Attorne ,6St fL Date:1/5/2021 <br /> 4C5FKDDFOB94% <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 6 <br />