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ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Seegars Fence CompanyParty/Vendor Contact Person: Jason DanielsContact Phone: 919-489- <br />5303Party/Vendor Address: PO Box 61378City DurhamState: NCZip: 27715Department: AMSAmount: $935 <br />Purpose: 113Mayo Street fence repair Budget Code(s): 10240320-570001Vendor # 41409(N/A if new vendor) <br />Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment <br />Effective Date 10/24/2017Approved by Board Yes No Agenda Date: <br />This agreement is approved as to technical form and content: <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___________________________________ Date: ________ <br />Risk Management <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br />Office of the Risk Management Officer___________________________________ Date: _________ <br />Financial Services <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br />Office of the Chief FinancialOfficer ____________________________________ Date: _________ <br />Legal Services <br />This agreement is approved as to legal form and sufficiency: <br />Office of the County Attorney __________________________________________Date: ________ <br />Clerk to the Board <br />Received for record retention: <br />All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov <br />The following signature block is for hard copies only and is not requiredfor Docusign contracts: <br />Office of the Clerk to the Board __________________________________________Date:_________ <br />Revised 2/17 5 <br />DocuSign Envelope ID: FD9947AB-B386-446B-AFDD-4088AF7B1812 <br /> <br /> <br /> <br />