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Revised 10/17 <br />9 <br />ORANGE COUNTY—DEPARTMENT USE ONLY <br />______________________________________________________________________________ <br />Department <br /> <br />Party/Vendor Name: Simmons & Simmons Management, Inc. Party/Vendor Contact Person: David Simmons <br />Contact Phone: 910-592-3834 Party/Vendor Address: P.O. Box 1460 City Clinton State: NC Zip: 28329 <br />Department: Solid Waste Amount: 27,500.00 Purpose: Grind and Haul Storm Debris Budget Code(s): 50351020- <br />630000 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: <br />(Check one) New Renewal Amendment Effective Date December 21, 2018 Approved by Board Yes <br /> No Agenda Date: N/A <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 /> <br />DocuSign Envelope ID: 4A6BB46E-AAA0-4B28-B7AE-906C41CB73D6 <br /> <br /> <br /> <br />