R 2017-024-E AMS - Asphalt on Demand Services for undercut 6" and backfill parking lot

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lope ID: F4E9815A-D9D2-4217-83BE-B882B3C57138 ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Asphalt on Demand Services Party/Vendor Contact Person: Tim O'Donnell (tim.o @asdinc.net) Contact Phone: 919.524.1979 Party/Vendor Address: 959 Short Journey Road City Smithfield State: NC Zip: 27577 Department: AMS Amount: 5580 Purpose: Undercut 6" and backfill parking lot Budget Code(s): 61370035-880000-30029 Vendor # 64082 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New ❑ Renewal ❑ Amendment ® Effective Date 1/16/17 Approved by Board Yes❑ No Agenda Date: This agreement is approved as to technical form and content: Department Director's Signature ° '"° Date: 1/18/2017 C9 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 sufficiency of insurance standards, specifications,and requirements: �—oos�gea ey: Office of the Risk Management Officer,_,,_X6""" 0 Date: 1/19/2017 Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: �—oos�gea ey: Office of the Chief Financial Officer ' Date: 1/21/2017 Legal Services This agreement is approved as to legal form and sufficiency: �—oos�gea ey: Office of the County Attorney, 9600 hwts Date: 1/23/2017 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@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 6/16