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3 <br /> ORANGE COUNTY-INTERNAL USE ONLY <br /> Finance Information <br /> Vendor Name: Vendor Contact Person: Phone: Address: City State: Zip: <br /> 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 /> Biddin <br /> ❑ Informal Bidding($30k-$90k); ❑ 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 work on this project <br /> 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 begun or been <br /> 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/software 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 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 <br />