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<br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Four Star Petroleum Services, Inc. Party/Vendor Contact Person: Cecil Morgan/Victor Foti <br /> Contact Phone: 540-563-1022 Party/Vendor Address: 1119 Beaumont Rd City Roanoke State: VA Zip: 24019 <br /> Department: Solid Waste Amount: 35,855.13 Purpose: Relocate tank Budget Code(s): 50351020-630003 Vendor <br /> #N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New <br /> Renewal❑ Amendment ❑ Effective Date 9-16-15 Approved by Board Yes❑No® Agenda Date:N/A <br /> This agreement is approved as to technical form apf content: <br /> Department Director's Signature Date: O /� <br /> Information Technologies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer �/lQ Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer 1��? &n� Date: /v i 4 JS <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: ,, Q <br /> Office of the Chief Financial Officer "Date- <br /> G <br /> Legal Services <br /> This agreement is approved as to legal florin d sufficie <br /> Office of the County Attorne - Date: <br /> Y <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloy @oran eg c� ny�c.gov <br /> The following signature block is for hard copies only of equired for Docusign contracts: rn / <br /> Office of the Clerk to the Board Date: `r <br />