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DocuSign Envelope ID: 1 DE4E8C1-837F-42D1-B56B-39F84301386C <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: The Water Specialist Party/Vendor Contact Person: Shane (Shane @thewaterspecialist.com) <br /> Contact Phone: 919-732-1578 Party/Vendor Address: 608 Cornerstone Court City Hillsborough State: NC Zip: <br /> 27278 Department: AMS Amount: $11,453.05 Purpose: Install water filtration system to existing well to lower the <br /> iron and hardness levels Budget Code(s): 61370035-883000-10016 Vendor # 64736 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)New ® Renewal ❑ Amendment ❑ <br /> Effective Date 9/12/17 Approved by Board Yes' No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> Department Director's Signature 4 Date: 9/8/2017 <br /> Asset Management <br /> (Applicable only to construction contracts)This agreement has been reviewed and is approved as to construction <br /> services content and specifications: <br /> Office of the Asset Management Directo °" Date: 9/$/2017 <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> Office of the Risk Management Officer atria Co""`flo Date: 9/$/2017 <br /> Financial Services <br /> l " This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> 1/ Act: <br /> Office of the Chief Financial Officer el 4°"6" Date: 9/12/2017 <br /> 7NEM 81 ACO1409._ <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> U(�,�olun.rebi,vfs 9/14/2017 <br /> Office of the County Attorney t EA.o„EOBAass_ Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd(a)orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Revised 2/17 6 <br />