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ORANGE COUNTY - -- DEPARTMENT USE ONLY -- -HARD COPY ONLY <br />Department <br />Party/Vendor Name: Moffat Pipe Inc Party/Vendor Contact Person: Jesse DuClau Contact Phone: 919- 235 -5149 <br />Party/Vendor Address: 4901 Unicorn Dr. City Wake Forest State: NC Zip: 27587 Department: Planning _& <br />Inspections Amount: $-1j.3,933.03 Purpose: Change Order Budget Code(s): 61370035- 850000 Vendor # 64870 Vr eci- <br />(N/A if new vendor) Vendor is a BOCC o sultant? Yes ❑ No® Contract Type: (Check one) New ❑ 1 64 <br />Renewal ❑ Amendment 0 Effective Date 44jApproved by Board Yes❑ No❑ Agenda Date: <br />This agreement is approved as to technical fo an ent: <br />F <br />Department Director's Signature Date: <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 />Office of Risk Management Date: <br />Financial Services <br />i <br />This instrument has been pre - audited in the anner r q iced by the Local Government Budget and Fiscal Control <br />Act: <br />Office of the Chief Financial Officer Date: <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />!7 <br />���! (� <br />Office of the County Attorney Date: <br />Clerk to the Board <br />Received for record retention: <br />Office of the Clerk to the Board Date: <br />zIl yli e eta) ,.�I1 ov o� <br />Revised 10/17 <br />