HomeMy WebLinkAboutR 2019-420 DEAPR - National Center for Safety Initiatives background screenings DocuSign Envelope ID: B673B9B3-14E3-450C-9DE2-FF2487B6D530
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: National Center for Safety Intiatives, LLC Party/Vendor Contact Person: Chris Goodman
Contact Phone: 866.966.7412 Party/Vendor Address: 807 Broadway St, NE STE 300 City Minneapolis State: N1N
Zip: 55413-2490 Department: Environment, Agriculture, Parks & Recreation Amount: $2070.00 Purpose:
Background Checks Budget Code(s): 10511020 630000 Vendor#65490 (N/A if new vendor) Vendor is a BOCC
consultant? Yes ❑No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ Effective Date 7/15/19
Approved by Board Yes❑No® Agenda Date:
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 prior to execution of the agreement:
DocuSigned by:
Department Director's Signature FO aWJ sfavC Date: 7/2/2019
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that was
addressed:
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficienc ems'' :"stl1aa1ndards,specifications,and requirements:
Q�Sa C,brvicl�b 7/10/2019
Office of the Risk Management OfficeeeF�esoeass Date:
Financial Services
This instrument has been pre-audited i 1wquired by the Local Government Budget and Fiscal Control Act:
7/10/2019
Office of the Chief Financial Officer Date:
Legal Services
This agreement is approved as t e Y&ffl'A•d,,��s,ufficiency:
rG��►'T' 7/10/2019
Office of the County Attorney �-n33Enannd6a Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 12/18 4
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