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DocuSign Envelope ID:6391BOAE-362A-4C3C-9EO2-718ABE34457B <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Warren-Hay Party/Vendor Contact Person: Ron LaPann Contact Phone: 919-732-4362 <br /> Party/Vendor Address: PO Box 818 City Hillsborough State:NC Zip: 27278 Department: AMS Amount: $3917.00 <br /> Purpose: Commons HVAC Replacement Budget Code(s): 10240320-570000 Vendor# 25352 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal ❑ Amendment ❑ <br /> Effective Date 1/25/2019 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 /> DocuSigned by: <br /> PW& �bV1rotA.ln, 1/18/2019 <br /> Department Director's Signature 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: <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'7�s� <br /> c�g9M*lards,specifications,and requirements: <br /> x C6V'�tR,{f6 1/18/2019 <br /> Office of the Risk Management Officer CF9 7R8""40R Date: <br /> Financial Services <br /> This instrument has been pre-audited in the Dad by the Local Government Budget and Fiscal Control Act: <br /> +� � <br /> Office of the Chief Financial Officer �� Date: 1/18/2019 <br /> Legal Services <br /> This agreement is approved as to lega,ro-rl <br /> J6U11 <br /> �1"��lclency: <br /> J � 1/18/2019 <br /> Office of the County Attorney FAA3n:iRFnRAR4R.1i 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 12/18 4 <br />