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DocuSign Envelope ID: FC33DOBE- 4D4D- 45AF- 857C- 2498EBC91861 <br />ORANGE COUNTY - DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Penta Engineering Group, Inc Party/Vendor Contact Person: Dan Blair <br />(dblairna,pentaeng com) Contact Phone: 919 - 455 -0212 Party/Vendor Address: 4000 Miller Court West City <br />Norcross State: GA Zip: 30071 Department: AMS Amount: $4,140.00 Purpose: Asbestos Sampling at Whitted <br />A &B Roof Parapet Walls, Asbestos Sampling at Passmore Center Entrance for Expansion, Air Quality Testing at <br />208 South Cameron Street Board of Elections Budget Code(s): (Government Services Annex) 61370035-880000 - <br />10008 $1,950.00, (Whiffed Bldg A &B Parapet Walls Asbestos Sampling) 61370035- 882000 -30002 $940.00. <br />Passmore Center Renovation Asbestos Sampling) 61370035- 880000 -10023 $1,250.00 Vendor # 61470 (N /A if <br />new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br />Amendment ❑ Effective Date 12/29/2017 Approved by Board Yes❑ No® Agenda Date: <br />This agreement is approved as to technical form and content: <br />D_ Signed by: <br />Department Director's Signature[ Date 12/27/2017 <br />9EgggA45CF69M198... <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 <br />Risk Management <br />Date: <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />D sg aby: <br />Office of the Risk Management Office QGsa (Avuu ffe Date: 12 /28/2017 <br />yFeeFg„ ages ss... <br />Financial Services <br />E Plg This instrument has been pre- audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br />r0 S'g ea by: <br />Office of the Chief Financial Officer I A-411 " Date: 1/2/2018 <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />0—Sig a by: <br />Office of the County Attorney 4e� Date: 1/2/2018 <br />EAA3D33EDBA868g_. <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd(koran-et� countync.gov <br />The following signature block is for hard copies only and is not required for Docusign contracts: <br />Revised 10/17 <br />8 <br />