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Revised 10/17 <br />9 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Summit Design and Engineering Services Party/Vendor Contact Person: Tim Smith <br />(tim.smith@summitde.net) Contact Phone: 919.732.3883 Party/Vendor Address: 504 Meadowlands Drive City <br />Hillsborough State: NC Zip: 27278 Department: AMS Amount: $10,750.00, ($8,750.00 Fixed price for design, <br />$2,000 for reimbursables) Purpose: Provide design services for Piedmont Food & Ag Freezer Installation Budget <br />Code(s): 30600030-870000-71370 Vendor # 53403 (N/A if new vendor) Vendor is a BOCC consultant? Yes <br />No Contract Type: (Check one) New Renewal Amendment Effective Date 8/20/18 Approved by <br />Board Yes No Agenda Date: <br /> <br />This agreement is approved as to technical form and content: <br /> <br />Department Director’s Signature ________________________________________ Date: ________ <br /> <br /> <br />Information Technologies <br /> <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 /> <br />Office of the Chief Information Officer___________________________________ Date: ________ <br /> <br /> <br />Risk Management <br /> <br />This agreement is approved for sufficiency of insurance standards, specifications, and requirements: <br /> <br />Office of the Risk Management Officer___________________________________ Date: _________ <br /> <br /> <br />Financial Services <br /> <br />This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br />Act: <br /> <br />Office of the Chief Financial Officer ____________________________________ Date: _________ <br /> <br /> <br />Legal Services <br /> <br />This agreement is approved as to legal form and sufficiency: <br /> <br />Office of the County Attorney __________________________________________Date: ________ <br /> <br /> <br />Clerk to the Board <br /> <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 /> <br />Office of the Clerk to the Board __________________________________________Date:_________ <br /> <br /> <br />DocuSign Envelope ID: 3BB200F6-4761-46CD-8B69-0FE9970D5654 <br /> <br /> <br /> <br />