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DocuSign Envelope ID:28DAOOF8-4193-4AO9-B5AF-6D4761A9B655 <br /> ORANGE COUNTY---DEPARTMENT USE ONLY---HARD COPY ONLY <br /> Department <br /> Party/Vendor Name: Four Star Petroleum Services, Inc. Party/Vendor Contact Person: Cecil Morgan Contact <br /> Phone: 540-691-5847 Party/Vendor Address: 1119 Beaumont Rd City Roanoke State: VA Zip: <br /> Department: Solid Waste Amount: $44,244.03 Purpose: Construction (move of Fuel Tank) Budget Code(s): <br /> 50353030-880000 Vendor# (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one)New ❑ Renewal ❑ Amendment ® Effective Date Approved by Board Yes❑ No <br /> ® Agenda Date: <br /> This agreement is approved as to technical form an�1 content: <br /> DocuSign by: <br /> Department Director's Signature (Akso" Date:9/22/2016 <br /> 6E763F604A144E2... <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 insurance standards,specifications, and requirements: <br /> DocuSigned by: <br /> Office of Risk Management && (,bnxffb Date: 9/22/2016 <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 Date: <br /> 9/22/2016 <br /> �s °" a°'z <br /> 7D4E5181ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal fo> n and s� fficiency: <br /> igne y: <br /> Office of the County Attorney <br /> F�;Zs 15r dot, Date: 9/23/2016 <br /> 328DC480549A4F5... <br /> Clerk to the Board <br /> Received for record retention: <br /> Office of the Clerk to the Board Date: <br />