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ORANGE COUNTY-INTERNAL USE ONLY <br /> Finance Information <br /> Vendor Name : Vendor Contact Person : Phone : Address : Ciry . State : <br /> Zip : Department: Amount : Purpose : Budget Code(s) : Vendor # <br /> Vendor Status with NCSOS : Vendor is a BOCC consultant: ❑Yes ❑ No <br /> Contract Details <br /> Contract Type : ❑ New ❑ Amendment (Original Contract: ) (Most Recent Amendment ) <br /> Effective Date End Date Notice Date (Notice Purpose ) <br /> Award <br /> ❑ Approved by Board (Agenda Date : ) ; ❑ Made or Administered by <br /> Signature Authority <br /> ❑ BOCC Express Delegation (Agenda Date : ) <br /> Policy 9 .4 : ❑Under $5 ,000 ; ❑ Service Under $ 90, 000 ; ❑ Construction Under $ 250,000 <br /> ❑ Budget Policy Section XV (Capital Improvement Project: ) <br /> Bidding <br /> ❑ Informal Bidding ($ 30k490k) ; ❑ Formal RFP ($90k+) ; ❑ Other (<$ 30k) ; ❑ Exception(#_ . <br /> Department Affirmation <br /> ❑ This agreement is approved as to technical form and content and I as Department Director affirmatively state <br /> work on this project has not been initiated prior to execution of the agreement. <br /> ❑ This agreement is approved as to technical form and content . Services related to this agreement have already <br /> begun or been completed . Description of the nature of the emergency condition that was addressed : <br /> Department Director ' s Signature Date : <br /> Information Technologies <br /> This agreement has been reviewed and is approved as to information technology content and specifications : <br /> Office of the Chief Information Officer Date : <br /> ❑ Inapplicable because no hardware%softivare purchases or related services <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 <br /> 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 /> 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 /> Received for record retention : <br /> Office of the Clerk to the Board Date: <br /> Revised 01 / 24 9 <br />