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DocuSign Envelope ID:83CE5186-90BD-4376-B343-3887BADA96CD <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: r, V.Brockwell Trucking Party/Vendor Contact Person: Chuck Smith Contact Phone: 919-942- <br /> 3.001 Party/Vendor Address: 8821 Old NC 86 City Chapel Hill State:NC Zip:27516 Department: DEAPR Amount: <br /> $1,760.00 Purpose: Replenish certified playground safety surfacing Budget Code(s): 10515020 572000 Vendor # <br /> 42666 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New <br /> Renewal❑ Amendment ❑ Effective Date 9/4/2018 Approved by Board Yes[]No® Agenda.Date: <br /> This agreement is approved as to technical form and content:. <br /> DocuSigned by: <br /> Department Director's Signature awl �fat,.61 Date: 9/4/2018 <br /> 611CFA1D507A495... <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 Date: <br /> Risk Management <br /> This agreement is approved for sufficiency of insurance standards,specifications,and requirements: <br /> DDocuSigned by: <br /> Office of the Risk Management Officer 117FDCF9176800498 Gsa. C,6V1n.t,{�6 Date: 9/5/2018 <br /> .. <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> DocuSigned by: <br /> Office of the Chief Financial Officer 6m�, 00.'1440. Date: 9/5/2018 <br /> .. <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Docusigned by: <br /> Office of the County Attorney �66A, K6kk(S Date: 9/27/2018 <br /> EAAM33ED8AW5... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: sin ersoll_,oran ecountync.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 14117(Mgr appry A 6118) 4 <br /> I <br />