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DocuSign Envelope ID: 3038F92E-742A-4AA4-BDCE-980F4D400885 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Fire Safe Chimney Sweep Party/Vendor Contact Person: Bob Perera Contact Phone: <br /> 919.304.6111 Party/Vendor Address: 4127 Hidden View Dr City Mebane State: NC Zip: 26302 Department: <br /> DEAPR Amount: $3,409.83 Purpose: Repair/reno chimney Budget Code(s): 61370035 880000 20039 Vendor# <br /> 64848 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No Contract Type: (Check one)New <br /> Renewal ❑ Amendment ❑ Effective Date 11/10/2017 Approved by Board Yes❑Non Agenda Date:_ <br /> This agreement is approved as to technical form and content: <br /> DocuSigned by: <br /> Department Director's Signature Sf A,IAtt Date: 11/16/2017 <br /> 611CFA1D507A495... <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 /> DocuSigned by: <br /> Office of the Asset Management Director ?o+wpoon Date: <br /> 11/21/2017 <br /> 9E880A46CF64498... <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DocuSigned by: <br /> Office of the Risk Management Officer rLtSa, Cbrin'ft Date: 11/22/2017 <br /> 7FDCF9176800498... <br /> ( <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 11/22/2017 <br /> C7? Date: <br /> 7D4E5181ACC1409_ i. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> DocuSigned by: <br /> Office of the County Attorney 1O(UA. bt tY S Date: 11/22/2017 <br /> EAA3D33ED8A8465... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ DolloydAorangecountync.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 6 <br /> I <br />