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ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br />Party/Vendor Name: Quality Air Tools RaleighParty/Vendor Contact Person: Lyndsay StormsContact Phone: 919- <br />329-9650Party/Vendor Address: 3713 Conquest DriveCity GarnerState: NCZip: 27529Department: AMS <br />Amount: $1682.38Purpose: 80 gallon vertical tank installBudget Code(s): 10240420-630000Vendor # 58181(N/A <br />if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal <br />Amendment Effective Date 11/02/2018Approved 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 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 />Revised 10/17 (Mgr apprv 5k 6/18)4 <br />DocuSign Envelope ID: 6CE9F4FB-27D4-4B9A-A269-DDC1952921CB <br /><br /> <br /><br /> <br /> <br /> <br /> <br />