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DocuSign Envelope ID:02FOB961-A92E-4131E-AOE9-E5777906432F <br /> ORANGE COUNTY DEPARTMENT USE ONLY <br /> Deuartment <br /> Party/Vendor Name: Blossman Gas, Inc., d/b/a Alliance Autogas Party/Vendor Contact Person: Michael Phillips <br /> Contact Phone: 704-574-4927 Party/Vendor Address: 2091 US Highway 70 City Swannanoa State: NC Zip: <br /> 28778 Department: AMS Amount: not to exceed $450,000 as part of the County fuel budget Purpose: The <br /> provision of propane vehicle fuel pursuant to Exhibit A:Alliance Aurogas Customer Agreement,dated 7-1- <br /> 2015 Budget Code(s): 10240420-5460100 Vendor 4 63490 (N/A if new vendor) Vendor is a BOCC consultant? <br /> Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 7-1-2015 <br /> Approved by Board Yes®No❑ Agenda Date: 6-16-2015 <br /> This agreement is approved as to technical fo— <br /> rn;.4r nt: <br /> Department Director's Signature 66 1 Date: 11/25/2015 <br /> 9E880A46C F64498... <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 Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of ins} 9ee§t""an'dl1alLyds,specifications,and requirements: <br /> Office of the Risk Management Officer auSa (hm, b Date: 11/29/2015 <br /> 7FDCF9176800498... <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 /> DocuSigned by: <br /> Office of the Chief Financial Officer <br /> Date: 12/3/2015 <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and �fgceeacy: <br /> Office of the County Attorney 56"Ocu <br /> . �o ufs Date: 12/3/2015 <br /> AA3D33EDSA8465... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Doll2ydLvorangecounlyne.go v <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/14 9 <br />