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DocuSign Envelope ID: EDADB5F3-AB85-4DD0-B1F0-1A82D3B4751B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Systel Business Equipment Party/Vendor Contact Person: Michelle Shepard Contact Phone: <br /> (336) 808-8000 Party/Vendor Address: P.O.Box 3591 City Fayetteville State: NC Zip: 28303 Department: <br /> Department of Social Services Amount: $4,392.00 Purpose: Copier for DSS Budget Code(s): 10400120-590000 <br /> Vendor# 11999 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) <br /> New® Renewal ❑ Amendment ❑ Effective Date 2February2021 Approved by Board Yes❑No® Agenda <br /> 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 exe "fthepftgreement: <br /> Department Director's Signature N- " - I S}b5 Date: 2/2/2021 <br /> Agreements for emergency services or repair are not subject to 15'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 sp "f *Ua by: <br /> hh�� Na <br /> Office of the Chief Information Officer J Date: 2/2/2021 <br /> Risk Management <br /> This agreement is approved for sufficiency of insuranc &A%,%pecifications,and requirements: <br /> Office of the Risk Management Officer &A, YW16 Date: 2/3/2021 <br /> 4913 <br /> Financial Services <br /> This instrument has been pre-audited in the manner r %y+ed*:Local Government Budget and Fiscal Control Act: <br /> Office of the Chief Financial Officer rqta 0 Date: 2/3/2021 <br /> sa€3+staoc�a <br /> Legal Services <br /> This agreement is approved as to legal form and su 'em�enea by: <br /> Office of the County Attorney dams br�a"' Date: 2/3/2021 <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 />