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Revised 06/21 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />_____________________________________________________________________________________________________ <br />Party/Vendor Name: NetPlanner Systems, Inc Party/Vendor Contact Person: Mike Dycus Contact Phone: 770.833.3130 Party/Vendor Address: 1229 <br />Perry Road, Suite 108 City Apex State: NC Zip: 27502 Department: OCIT Amount: 10,000.00 Purpose: Change Order 3 to Outside Plant Fiber Optic <br />Infrastructure per RFP#367-OC5301 Budget Code(s): 61370035-897086-30007 Vendor # 67077 (N/A if new vendor) Vendor is a BOCC consultant? <br />Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 8/30/2022 Approved by Board Yes No Agenda <br />Date: --- For Section XIV. c. contracts only, Approved by Board in Current FY Budget Yes No <br />This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated <br />prior to execution of the agreement: <br />Department Director’s Signature ________________________________________ Date: ________ <br />Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been <br />completed please briefly describe the nature of the emergency condition that was addressed: N/A <br />Risk Management <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <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 />DocuSign Envelope ID: 6884E077-E2E1-49CB-9160-FF791CF982BA <br />8/30/2022 <br />8/30/2022 <br />8/30/2022 <br />8/31/2022