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DocuSign Envelope ID:AD251 D55-21 B9-4E45-B277-2076A6D0468D <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Four Star Petroleum Services, Inc. Party/Vendor Contact Person: Cecil Morgan Contact <br /> Phone: 540-563-1022 Party/Vendor Address: 1119 Beaumont Rd. City Roanoke State: VA Zip: 24019 <br /> Department: Solid Waste Amount: 2,135 Purpose:Provide and Install Pressure Regulating Valve Budget Code(s): <br /> 50351020-571000 Vendor#64044 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract <br /> Type: (Check one) New ® Renewal ❑ Amendment ❑ Effective Date 11-15-17 Approved by Board Yes' <br /> No Agenda Date: <br /> This agreement is approved as to technical form and content: <br /> ,,---DocuSigned by: <br /> Department Director's Signature G-ordoA, `1%vcloi Date:11/16/2017 <br /> 25E5DBCA7B8941B... <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 /> r---DocuSigned_by: <br /> 'll <br /> ,tl6 <br /> Office of the Risk Management Officer ltttSA. rbvwc Date: 11/20/2017 <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 /> 11/20/2017 <br /> Office of the Chief Financial Officer (71.4.-N D-7D4E5181 ACC1409... <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney <br /> at,UU, '4tI, 1 sco Date: 11/20/2017 <br /> `—079A4D525C0F4FB... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/17 <br /> 8 <br />