HomeMy WebLinkAboutR 2019-593 DEAPR - Amiel Elbitar-Hartwell Start Smart lacrosse contract DocuSign Envelope ID:6066AD9F-OD78-422D-B879-352372F3B41B
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Amiel Elbitar-Hartwell Party/Vendor Contact Person: Amiel Elbitar-Hartwell Contact Phone:
919-724-0268 Party/Vendor Address: 108 Scarlett Dr. Unit B City Chapel Hill State: NC Zip: 27516 Department:
DEAPR-Recreation Amount: $623.00 Purpose: To Instruct Start Smart Lacrosse Budget Code(s): 10511020 630000
Vendor# 64826 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)
New ® Renewal ❑ Amendment ❑ Effective Date Sept. 9,2019 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:
awl gga ,a 8/29/2019
Department Director's Signature 1P.,1cFA1D507A495.. Date:
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 sufficient Docu5igneda LQ_by:. rds,specifications,and requirements:
aUS 6 8/29/2019
Office of the Risk Management Office Datc:
7FDCF9178800498.
Financial Services
This instrument has been pre-audited ii Docusigned by: - the Local Government Budget and Fiscal Control Act:
('� � �
Office of the Chief Financial Officer Date:8/30/2019
7D4E5181ACC1400.
Legal Services
This agreement is approved as t DocuSigned by: iclency:
,�6�.Jn. �b�W�S 9/3/2019
Office of the County Attorney EAM D33ED8AM65.. 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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