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ORANGE COUNTY - -- DEPARTMENT USE ONLY -- -HARD COPY ONLY <br />Department <br />Party /Vendor Name: NCDEQ Party/Vendor Contact Person: Christopher J. Sandt, P.E., Staff Engineer <br />Contact Phone: 919- 245 -2583 Party/Vendor Address: 3800 Barrett Drive City Raleigh State: NC Zip: 27609 <br />Department: Planning Amount: $520 (associated NCDEQ application fee) Purpose: NEED COUNTY MANAGER <br />SIGNATURE ON FINANCIAL RESPONSIBILITY /OWNERSHIP FORM FOR NCDEQ EROSION AND <br />SEDIMENT CONTROL PERMITTING OF THE HILLSBOROUCM AREA EDD WATER AND SEWER <br />EXTENSION PROJECT Budget Code(s): 61370035- 850000 -30048 or #N /A (N /A if new vendor) Vendor <br />is a BOCC consultant? Yes ❑ No® Contract Type: (Check oAl>ew ❑ Renewal ❑ Amendment <br />Effective Date July 9, 2018 Approved by Board Yes❑ No® Agenda Date: <br />This agreement is approved as to technic rm an tent: <br />67 <br />Department Director's Sign at 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 />This instrument has been pre- audited i <br />Act: <br />Office of the Chief Financial Officer <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />ment Budget and Fiscal Control <br />Date: 7/J,, b <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 <br />Revised 10/17 <br />Date: <br />I h I (_� <br />