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7 <br /> <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />________________________________________________________________________ <br /> <br />Party/Vendor Name: Party/Vendor Contact Person: Contact Phone: Party/Vendor <br />Address: City State: Zip: Department: Amount: Purpose: <br /> Budget Code(s): Vendor # (N/A if new vendor) Vendor is a BOCC consultant? <br />Yes No Contract Type: (Check one) New Renewal Amendment Effective Date <br />Approved by Board Yes No Agenda Date: <br /> <br />This agreement is approved as to technical form and content and I as Department Director affirmatively <br />state work on this project has not been initiated prior to execution of the agreement: <br /> <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br />Agreements for emergency services or repair are not subject to the above affirmation. If services related to <br />this agreement have already begun or been completed please briefly describe the nature of the emergency <br />condition that was addressed: <br /> <br />Information Technologies <br /> <br />(Applicable only to hardware/software purchases or related services) This agreement has been reviewed <br />and is approved as to information technology content and specifications: <br /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal <br />Control Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> UNC SOM #18-0743.t004DocuSign Envelope ID: 86EFBE80-B26A-4B98-984D-32FF25A95668