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Revised 10/17 (Mgr apprv 5k 6/18)4 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Douglas P. MalinowskiParty/Vendor Contact Person: Douglas P. MalinowskiContact Phone: <br />919-810-6282Party/Vendor Address: 1005 Dimmocks Mill RoadCity HillsboroughState: NCZip: 27278 <br />Department: PlanningAmount: $3,300.00Purpose: Efland Sewer - Easement Clearing (Fall 2018)Budget Code(s): <br />51360120-571000Vendor # 64686(N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract <br />Type: (Check one) New Renewal Amendment Effective Date October 05, 2018Approved by Board Yes <br />No Agenda Date: N/A <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 Financial Officer ____________________________________ 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 Sherri Ingersoll upon completion: singersoll@orangecountync.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 />DocuSign Envelope ID: 0367C8AB-A6A6-4692-81B5-A3CECE426B4E <br /> <br /> <br /> <br />