R 2017-167-E DEAPR - JV Brockwell Trucking to replenish playground safety surfacing

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DocuSign Envelope ID: D7D97625-274B-4FD2-B140-A54CC257D87C ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: JV Brockwell Trucking Party/Vendor Contact Person: Chuck Smith Contact Phone: (919) 942- 3001 Party/Vendor Address: 8821 Old NC86 City Chapel Hill State:NC Zip:27516 Department: DEAPR Amount: $1,760.00 Purpose: Replenish playground safety surfacing Budget Code(s): 10515020 630000 and 572000 Vendor# 42666 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type: (Check one)New Renewal❑ Amendment ❑ Effective Date 5/10/2017 Approved by Board Yes❑No Agenda Date: This agreement is approved as to technical form and content: DocuSigned by: Department Director's Signature Piw.L Sltiad, Date: �--611CFA1D507A495.,. 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: DocuSigned by: Office of the Risk Management Officer ((USX ( rt&L*& Date: �---7FDCF9178800498... Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: Office of the Chief Financial Officer Date: �---7D4E5181ACC1409... Legal Services This agreement is approved as to legal form and sufficiency: DocuSigned by: Office of the County Attorney (LA, (AA Date: EAA3D33ED8A8465... 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 2/17 5