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DocuSign Envelope ID: F90Cl87C-FA90-4F9D-8F69-89C8CB5166DB <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Party/Vendor Name: Herndon Party/Vendor Contact Person: Becky Herndon Contact Phone: 919-477-0451 <br /> Party/Vendor Address: 4310 N. Roxboro Rd City Durham State: NC Zip: 27704 Department: Solid Waste Amount: <br /> 685.00 Purpose: Repair Ice Machine Budget Code(s): 50350020-570000 Vendor # 52106 (N/A if new vendor) <br /> Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one) New ® Renewal ❑ Amendment ❑ <br /> Effective Date 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 /> " 'siigne'd1 by: <br /> F40cu <br /> u (AWWAS 2/7/2019 <br /> Department Director's Signature De 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 insurance standards,specifications,and requirements: <br /> DocuSigneed by: <br /> Office of the Risk Management Officer PUS& r6�6 Date: 2/10/2019 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in"9ftWPcttnquired by the Local Government Budget and Fiscal Control Act: <br /> [ rJ."_4 2/11/2019 <br /> Office of the Chief Financial Officer C74 Date: <br /> Legal Services <br /> This agreement is approved as to le fikwusiw*dtmfficiency: <br /> Ql�t,lAL L �Stb 2/11/2019 <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 12/18 4 <br />