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c�2vIB 6,55 <br />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: $4,000.00 Purpose: Change Order Budget Code(s): 61370035- 880000 -10054 Vendor # <br />64870 (N /A if new vendor) Vendor is a BOCC consultant? Yes ❑ NoN Contract Type: (Check one) New ❑ <br />Renewal ❑ Amendment N Effective Date 7/10/17 Approved by Board Yes❑ No❑ Agenda Date: <br />This agreement is approved as to technical and content: <br />Department Director's Signatur 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 />1 <br />Office of Risk Management Date: ? /'� / / �, <br />Financial Services <br />This instrument has been pre - audited in th ma r uired by the Local Government Budget and Fiscal Control <br />Act: <br />Office of the Chief Financial Officer Date: 7 / <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />d' q <br />Office of the County Attorney ; -` Date: I �- <br />Clerk to the Board <br />Received for record retention: <br />Office of the Clerk to the Board Date: <br />Revised 10/17 <br />