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DocuSign Envelope ID:7159AAC9-BBC3-4043-A66F-C3FO56DOBD56 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Systel Business Equipment,C.,Inc. Party/Vendor Contact Person: Michelle Shepard Contact <br /> Phone: (336) 808-8000 x2510 Party/Vendor Address: P.O. Box 3591 City Fayetteville State: NC Zip: 28303 <br /> Department: IT Amount: $3,741.12 Purpose: Dental Clinic Budget Code(s): 10410120/581000 Vendor# 11999 <br /> (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New <br /> Renewal ❑ Amendment ❑ Effective Date 0lJu1,2� 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 <br /> on this project has not been initiated prior to execution of the agreement: <br /> [DocuAA'`` by: <br /> signed <br /> titIUDDepartment Director's Signature Date: 7/1/2020 <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 s b�ai�JiitFiy: <br /> 71/2020 <br /> ^� Na / <br /> Office of the Chief Information Officer J Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insur catmWer&I,specifications,and requirements: <br /> Office of the Risk Management Officer &A. rbvvulTO Date:7/1/2020 <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 /> Office of the Chief Financial Officer 0.11&1�1 Date: 7/2/2020 <br /> !A <br /> 661409... <br /> Legal Services <br /> This agreement is approved as to legal form and s ^ft@nuSianed by: <br /> Jet'-.7S'���� 7/2/2020 <br /> Office of the County Attorney Date: <br /> �e�aos4sA4rs... <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 <br /> 9 <br />