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DocuSign Envelope ID:26463C8C-1673-4776-BEDE-B251C04B9900 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Hillsborough Plumbing Company Party/Vendor Contact Person: Shannon Roberts Contact <br /> Phone: 919-732-4506 Party/Vendor Address: 1020 Hwy 57 N City Hillsborough State: NC Zip: 27278 Department: <br /> AMS Amount: $4957.50 Purpose: Cedar Grove Septic Repair Budget Code{s): 1024U320-570000 Vendor#58196 <br /> (N/A if new vendor) Vendor is a BDCC consultant? Yes ❑No❑ Contract Type:(Check one)New ❑ Renewal <br /> ❑ Amendment ❑ Effective Date 10/22/18 Approved by Board Yes❑No❑ Agenda Date: <br /> This agreement is approved as to technical for 1P9E88CA4,GCF64408 eocu5igned by: <br /> V`�6 7AO V ,, 10/26/2018 <br /> Department Director's Signature .. Date: <br /> Information Technologies <br /> (Applicable only to hardivarelsoftware purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficiency or'°`ii cus�gnea`6y "'` specifications,and requirements: <br /> Qusa (,bV1n.t 6 10/26/2018 <br /> Office of the Risk Management Officer Date: <br /> 3FDCF917E800438... _ <br /> I <br /> Financial'Services <br /> This instrument has been pre-audited in the ma eocu5igned ay: al Government Budget and Fiscal Control Act: <br /> A . 10/29/2018 j <br /> Office of the Chief Financial Officer Date: <br /> 7D4E5181ACC14i79... <br /> Legal Services <br /> This agreement is approved as to legal fora DocuSigned by: <br /> Office of the County Attorney 6L W Ifs Date: 10/30/2018 <br /> EAMMaED8A&W5... <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 10/17(Mgr appry 5k 611$) 4 <br />