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DocuSign Envelope ID:COFFFEC3-61D5-446A-B969-A61327D203D9 <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Environmental Solutions Group, LLC Party/Vendor Contact Person: Dan Whittaker <br /> (dwhittakerAjzo-esR com) Contact Phone: 336.392.8526 Party/Vendor Address: 1000 N. Elm Street City Greensboro <br /> State:NC Zip: 27401 Department: AMS Amount:NTE: $2,000.00 Purpose: Provide surface and air quality sampling <br /> at the John Link Government Services Building Budget Code(s): 10240320-630000 Vendor # 65016 (N/A if new <br /> vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ <br /> Amendment ❑ Effective Date 1/4/19 Approved by Board Yes❑No® Agenda Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work on <br /> this project has not been initiated prior to execution of the agreement: <br /> � P/anx� 1/3/2019 <br /> Department Director's Signature[IX — Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that was <br /> addressed: N/A <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 Office KSu bn1t f° Date:1/3/2019 <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: <br /> PL <br /> Office of the Chief Financial Office �N "` Date: 1/4/zo19 <br /> Legal Services <br /> This agreement is approved as to legal form and sufficiency: <br /> Office of the County Attorney k�rov s Date:1/8/2019 <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 12/18 4 <br />