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ORANGE COUNTY—DEPARTMENT USE ONLY C-20� - 5c2Z-9 <br /> Department V n& — D vvy 3 vd-OLS <br /> Party/Vendor Name: City of Mebane Party/Vendor Contact Person: Chris Rollins Contact Phone: (919)304-9206 <br /> Party/Vendor Address: 106 E Washington St City Mebane State:NC Zip:27302 E*artment: Planning Amount: <br /> $60,000 Purpose: Efland Sewer Maintenance Budget Code(s): 51360120-i710004endor# 800039 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ NoN Contract Type: (Check one) New E Renewal ❑ <br /> Amendment ❑ Effective Date April 29,2016 Approved by Board Yes❑NoN Agenda Date: <br /> This agreement is approved as to technical and nd ntent- <br /> Department Director's Signatur ZjDate: <br /> Information Technologies <br /> (Applicable only to hardwarelsoftware 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 insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer_ Date:-"h 1, <br /> ,v —7— <br /> Financial Services <br /> This instrument has been pre-audited in the otter r aired y the Local Government Budget and Fiscal Control <br /> Act: <br /> Office of the Chief Financial Officer Date: 4 <br /> Leeal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney Z-� Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolIL)Yd@oranpecounwc.gov <br /> The following signature block is for hard copies only is re ytired for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> V// <br />